Ureteral Stones Research Articles

Comparative Efficacy of Shockwave Lithotripsy and Ureteroscopy in Treating Renal and Ureteral Stones

Comparative Efficacy of Shockwave Lithotripsy and Ureteroscopy in Treating Renal and Ureteral Stones

Construction and performance of a clinical prediction rule for ureteral stone without the use of race or ethnicity: A new STONE score.

The original STONE score was designed to predict the presence of uncomplicated renal colic and the corresponding absence of alternate serious etiologies. It was retrospectively derived and prospectively validated and resulted in five variables: Sex (male gender), Timing (acute onset of pain), "Origin" (non-Black race), Nausea/vomiting (present), and Erythrocytes (microscopic hematuria). With recent increased awareness of the potential adverse impacts of including race (a socially constructed identity) in clinical prediction rules, we sought to determine if a revised STONE score without race could be constructed with similar diagnostic accuracy. We used data from the original STONE score that utilized retrospective data on patients with confirmed kidney stone by computed tomography (CT) to derive a clinical prediction rule as well as prospective data to validate the score. These data were used to construct a revised STONE score after removing race as a variable. We performed univariate and multivariable logistic regression and compared the old and new STONE scores (including multivariable, integral, and three-level risk) using the area under the receiver operating characteristic curve (AUC) and misclassification rates. After the elimination of race, multivariable logistic regression revealed that gross hematuria was the next strongest feasible variable for the prediction of ureteral stone. This was incorporated into a revised STONE score by substituting "obvious hematuria" for "origin" (formerly race). The revised STONE score had similar predictive accuracy to the original STONE score: AUC 0.85 versus 0.86 (95% confidence interval [CI]: 0.82-0.87 and 0.79-0.93); misclassification rates were also unchanged, 0.23 versus 0.23 (95% CI: 0.20-0.25 and 0.20-0.25). We modified the STONE score to remove race and include "obvious hematuria" without losing clinical accuracy. Considering the potential adverse effects of propagating racial bias in clinical algorithms, we recommend using the revised STONE score. Future research could investigate the potential contributions of social drivers of health (SDOH) to the diagnosis of kidney stone.

A rare complication after ureterorenoscopy lithotripsy: Subcapsular renal hematoma.

To evaluate the prevalence, risk factors, clinical manifestations, and outcomes of subcapsular renal hematoma (SRH) following ureterolithotripsy. Between January 2014 and December 2023, patients who underwent ureterorenoscopy lithotripsy (URL) at our hospital were retrospectively reviewed. Clinical data including basic information, calculi-related indicators, and perioperative period data were collected. A Student's t-test was used for continuous data, while a Chi-square test or Fisher's exact test was utilized for categorical data. A total of 2098 patients treated with URL for ureteric stones were included in this study. The incidence of SRH after URL was 0.52% (11 cases). All SRH cases were confirmed by non-contrast computed tomography, with an average patient age of 55.54 years (range 34-84). The mean stone size in patients with SRH was 10.54 cm (range 0.8-1.5). Patients with SRH had a higher proportion of severe hydronephrosis caused by ureteral stones (54.55% vs 26.07%, p = 0.032) and narrow ureters (45.45% vs 8.04%, p < 0.001) compared to those without SRH. Patients with SRH experienced a longer length of stay, with a significant difference between the two groups (11.64 ± 5.05 vs 3.87 ± 8.12, p < 0.001). Nine patients were managed conservatively without further intervention, while embolization was required in one patient and percutaneous drainage was performed in another. All SRH cases resolved completely during a 4-month follow-up. The incidence of SRH following URL is low, with severe hydronephrosis and narrow ureters identified as risk factors. Most SRH cases can be successfully managed conservatively, although patients with SRH may experience a significant prolongation of their length of stay.

COMPARISON OF LASER AND PNEUMATIC LITHOTRIPSY FOR MID AND LOWER URETERAL STONES: “AN ANALYTICAL REVIEW” AT TERTIARY CARE CENTER

Objectives: Management of large lower and mid ureteric stones represents a treatment challenge. The main objective of stone treatment is to achieve the highest stone-free rate with minimal morbidity. Available modalities are medical therapy, open surgery, laparoscopic surgery, endoluminal surgery and extracorporeal shock wave lithotripsy (ESWL). After the invention of uretero-renoscopy (URS) and ESWL in 1980s, there has been a paradigm shift in the treatment modality of ureteric calculus from open surgery to endoluminal and non-invasive method. There are various modalities for stone fragmentation in URS – electrohydrolic lithotripsy, pneumatic. Ultrasonic, laser and dual energy source (Ultrasound+Pneumatic) Lithotripsy. Both laser lithotripsy (LL) and pneumatic lithotripsy (PL) have favourable outcomes The aim of this study was to compare efficacy of pneumatic versus laser lithotripters for Mid and lower ureteric calculi in regional population at KIMS, Hubballi. Methods: This was a prospective comparative study done in 116 cases of mid and lower ureteric calculi (58 in PL and 58 in LL) at karnataka institute of medical sciences, Huballi from May 2022 to November 2022. Patients were randomly divided into two groups: Group 1 had PL, while Group 2 had lithotripsy using a laser energy source. For PL group, 0.8 and 1 mm probe was passed through working channel of URS. LL was performed using a 100- W holmium:yttriumaluminium-garnet (YAG)-pulsed laser machine, with 365 μm fibres. Complications were graded according to the Clavien-Dindo Grading System. Results: In all, 116 patients (78 male and 38 female) with a mean age of 36.21 years were included in the study, Varying from 18 to 75 years. In group one 58 patients under went PL out of which 41 were males and 17 were females. In group two 58 patients under went LL out of which 37 were males and 21 were females. In group one (PL) mean operative with SD was 42.10±(10.16) min, and in group two (LL). Mean operative with SD was 46.78±(9.36) min, with p=0.011, which was statistically significant. Mean hospital stay ±SD (days) in PL group was 2.69±(0.730) days, and in group two LL mean hospital stay ±SD (days) was 2.40±(0.591) with p=0.019, which was statistically significant. In group one out of 58 patients, 11 patients had stone migration with % of an 18.96% and in group two out of 58 patients 2 patient had stone migration of, with % of 3.44%, with p=0.008, which is statistically very significant. Post operatively 7 patients in group one needed auxillary procedures, 3 patients needed ESWL, 3 patients needed. Re URSL and one patient needed bladder clot evacuation with DJ stenting, In all these patients stone size was larger than 15 mm, In Group 2 no patient needed Auxillary procedure, with p=0.003 which is statistically significant. Conclusion: Both pneumatic and LL are standard and safe techniques for the management of lower and mid ureteric calculi. Our study showed LL had less stone migration, and no need for reintervention.

092. Overview of the Prevalence of Chronic Kidney Disease (CKD) in Kidney and Ureter Stones at Zainoel Abidin Hospital Banda Aceh, 2021

Background: Kidney stones are a predictor and risk factor for CKD and the prevalence rate is 5-10% with comorbid factors which can increase the risk of CKD events. Chronic Kidney Disease (CKD) is a serious complication of urinary tract stones. Chronic kidney disease can occur as a result of urological procedures, obstruction or due to causes inherent in stone formation. Methods: This type of research is descriptive research using secondary data in the form of medical record data. The design of this research is cross sectional with data collection carried out retrospectively. The samples in this study were patients diagnosed with CKD in patients with ureteral stones or kidney stones at Zainoel Abidin Hospital, Banda Aceh. Samples were taken using the total sampling method. Results: In this study, 70 samples were taken and the results of this study based on gender are majority were found to be men 48 samples (68.6%), the most common age category was 41 - 50 years with 28 samples (40.0% ), the most common comorbid factor causing CKD was hypertension in 30 samples (42.5%), the type of urinary tract stones most often found was ureter stones, namely 34 samples (49.0%), and the most common location or urinary tract was ureter stones. bilateral, namely 22 samples (31.4%). Conclusion: The male gender most often experiences CKD due to complications from urinary tract stones, where the age range of 41 - 50 years is the age that experiences the most complications. The most common type of urinary tract stone is ureteral stone with a bilateral location.

The infection post flexible UreteroreNoscopy (I-FUN) predictive model based on machine learning: a new clinical tool to assess the risk of sepsis post retrograde intrarenal surgery for kidney stone disease.

To create a machine-learning model for estimating the likelihood of post-retrograde intrarenal surgery (RIRS) sepsis. All consecutive patients with kidney stone(s) only undergoing RIRS in 16 centers were prospectively included (January 2022-August 2023). adult, renal stone(s) only, CT scan (within three months), mid-stream urine culture (within 10 days). concomitant ureteral stone, bilateral procedures. In case of symptomatic infection/asymptomatic bacteriuria, patients were given six days of antibiotics according to susceptibility profiles. All patients had antibiotics prophylaxis. Variables selected for the model: age, gender, age-adjusted Charlson Comorbidity Index, stone volume, indwelling preoperative bladder catheter, urine culture, single/multiple stones, indwelling preoperative stent/nephrostomy, ureteric access sheath, surgical time. Analysis was conducted using Python programming language, with Pandas library and machine learning models implemented using the Scikit-learn library. Machine learning algorithms tested: Decision Tree, Random Forest, Gradient Boosting. Overall performance was accurately estimated by K-Fold cross-validation with three folds. 1552 patients were included. There were 20 (1.3%) sepsis cases, 16 (1.0%) septic shock cases, and three more cases (0.2%) of sepsis-related deaths. Random Forest model showed the best performance (precision = 1.00; recall = 0.86; F1 score = 0.92; accuracy = 0.92). A web-based interface of the predictive model was built and is available at https://emabal.pythonanywhere.com/ CONCLUSIONS: Our model can predict post-RIRS sepsis with high accuracy and might facilitate patient selection for day-surgery procedures and identify patients at higher risk of sepsis who deserve extreme attention for prompt identification and treatment.

Battle of the bots: a comparative analysis of ChatGPT and bing AI for kidney stone-related questions.

To evaluate and compare the performance of ChatGPT™ (Open AI®) and Bing AI™ (Microsoft®) for responding to kidney stone treatment-related questions in accordance with the American Urological Association (AUA) guidelines and assess factors such as appropriateness, emphasis on consulting healthcare providers, references, and adherence to guidelines by each chatbot. We developed 20 kidney stone evaluation and treatment-related questions based on the AUA Surgical Management of Stones guideline. Questions were asked to ChatGPT and Bing AI chatbots. We compared their responses utilizing the brief DISCERN tool as well as response appropriateness. ChatGPT significantly outperformed Bing AI for questions 1-3, which evaluate clarity, achievement, and relevance of responses (12.77 ± 1.71 vs. 10.17 ± 3.27; p < 0.01). In contrast, Bing AI always incorporated references, whereas ChatGPT never did. Consequently, the results for questions 4-6, which evaluated the quality of sources, were consistently favored Bing AI over ChatGPT (10.8 vs. 4.28; p < 0.01). Notably, neither chatbot offered guidance against guidelines for pre-operative testing. However, recommendations against guidelines were notable for specific scenarios: 30.5% for the treatment of adults with ureteral stones, 52.5% for adults with renal stones, and 20.5% for all patient treatment. ChatGPT significantly outperformed Bing AI in terms of providing responses with clear aim, achieving such aim, and relevant and appropriate responses based on AUA surgical stone management guidelines. However, Bing AI provides references, allowing information quality assessment. Additional studies are needed to further evaluate these chatbots and their potential use by clinicians and patients for urologic healthcare-related questions.

Visualizing the landscape of urolithiasis research from 1979-2023: a global bibliometric analysis of randomized clinical trials.

Urolithiasis is the most prevalent benign urological condition, imposing a significant burden on morbidity, disability, and healthcare costs globally. Despite its impact, comprehensive bibliometric analyses of randomized clinical trials (RCTs) related to urolithiasis, which are essential for advancing evidence-based medical practices, are lacking. This study aimed to examine the global research landscape and trends in RCTs focused on urolithiasis. This study used bibliometric techniques to analyze a selection of RCTs on urolithiasis published between 1979 and 2023. VOSviewer software version 1.6.20 was used to visualize international collaborations and perform a keyword analysis of the included articles. The main objective was to identify key research areas and focal points within the field of urolithiasis RCTs. Between 1979 and 2023, a comprehensive search identified 16,716 research articles on urolithiasis. A total of 693 relevant RCTs were found in the Scopus database. The number of publications has significantly increased over time, indicating a strong positive correlation (R² = 0.9303; P < 0.001). China was the top contributor, with 166 publications (23.95%), followed by the United States, with 130 publications (18.76%). Turkey and Iran contributed 44 (6.35%) and 62 (8.95%) publications, respectively. Citation analysis revealed an average of 28.13 citations per article, an h-index of 70, and a total of 19,493 citations. The co-occurrence analysis highlighted current research trends and key topics in urolithiasis RCTs, including 'comparative effectiveness of surgical and laser techniques and patient outcomes', 'medical expulsive therapy (MET) for ureteral calculi and clinical outcomes', 'systematic reviews and meta-analyses of RCTs investigating urolithiasis', and 'dietary interventions and correlations between stone composition and the risk of recurrence.' The bibliometric analysis provides an overview of research on urolithiasis RCTs. It examines global research trends and identifies new developments in the field. Our review identified key research themes, including systematic reviews and meta-analyses, dietary interventions, medical therapy for the expulsion of ureteral stones, and comparisons of surgical techniques-areas that will remain focal points in future research. This bibliometric analysis is an invaluable resource for researchers, clinicians, and policymakers, providing a complete overview of past and present research trends. Informed decision making can be promoted and guided in future research, ultimately improving management and understanding.

The relationship between neutrophil/lymphocyte ratio, platelet/neutrophil ratio, and risk of urosepsis in patients who present with ureteral stones and suspected urinary tract infection

The relationship between neutrophil/lymphocyte ratio, platelet/neutrophil ratio, and risk of urosepsis in patients who present with ureteral stones and suspected urinary tract infection

Surgical Approaches to Proximal Ureteral Stones &gt;1 Cm: A Comparative Study of M-PCNL and Semirigid URSL

Background: For the management of proximal ureteric calculi modalities like Extracorporeal shockwave lithotripsy, mini-Percutaneous Nephrolithotomy, UreteroRenoscopic Lithotripsy, and Retrograde Intra-Renal Surgery have been commonly used. The objective of this study is to compare the efficacy and safety of mini-Percutaneous Nephrolithotomy and semirigid Ureterorenoscopic Lithotripsy in terms of the total operation time, stone clearance rate, duration of hospital stays, post-operative hemoglobin drop, and peri-operative complications. Methods: This study was a hospital-based, prospective, comparative study conducted in the Urology Unit of Nepalgunj Medical College (NGMC). Eighty patients were included in the study, divided into two groups: 40 patients in the m-PCNL group (Group A) and 40 patients in the URSL group (Group B). Results: The mean age of the total patients was 36.34 ± 12.68 years. The mean duration of surgical procedure in m-PCNL Group was 26.93±9.43 minutes and in URSL it was 20.88±7.06 minutes. The mean duration of hospital stay in m-PCNL Group was 3.63±1.10 days and in URSL group it was 2.70±1.24 days. In m-PCNL, 5 cases (12.5%) had fever, 2 cases (5%) had hematuria and in URSL, 10 cases (25%) had a fever, 7 cases (17.5%) had hematuria and 1 case (2.5%) had dyspnea because of pulmonary complication. Conclusion: Our findings demonstrate that both m-PCNL and URSL can be done for proximal ureteric calculi &gt;1cm but m-PCNL has significantly better stone clearance with no residual stone and thus concludes m-PCNL is better than semirigid URSL for the management of proximal ureteric calculi greater than 1cm.

Urethral keratosis caused by vitamin A deficiency: two case reports

BackgroundDysuria in children can have various etiologies, including ureteric stones, phimosis, congenital obstructive posterior urethral membrane, and neurogenic bladders. However, there have been no reports of vitamin A deficiency (VAD) causing dysuria due to urethral keratosis. Here, we report two cases of urethral keratosis caused by a VAD.Case presentationAn 8-year-old boy (Patient 1) and a 6-year-old boy (Patient 2) presented with multiple episodes of dysuria and epididymitis. Both patients had intellectual disabilities and autism, which prevented voiding cystourethrography. Therefore, the patient was admitted for cystoscopy under general anesthesia. Cystoscopy revealed urethral diastolic dysfunction and a large amount of desquamated epithelium obstructing the urethra in both patients, causing urinary obstruction and dysuria. Catheterization was repeated; however, the symptoms recurred after catheter removal. Although the cause of recurrent urinary obstruction could not be initially identified, an ophthalmologist found Bitot’s spots and suggested the possibility of a VAD. Serum vitamin A levels were extremely low in both patients, leading to the diagnosis of urethral keratosis due to VAD. VAD can be attributed to an unbalanced diet resulting from intellectual disabilities or autism. Vitamin A replacement therapy improved both the urethral symptoms and cystoscopic findings.ConclusionDysuria due to VAD is extremely rare, and urethral keratosis as a cause of dysuria is likely the first report of its kind worldwide. VAD may develop due to an unbalanced diet in patients with intellectual disabilities or autism. Therefore, it is essential to consider VAD as a potential cause of dysuria in patients with intellectual disabilities and autism.

Predictive factors of stone-free rate and complications in patients with proximal impacted ureteral stones undergoing percutaneous nephrolithotomy: based on a new scoring standard.

To evaluate the predictive factors affecting the stone-free rate (SFR) and complications of percutaneous nephrolithotomy (PCN) in the treatment of proximal impacted ureteral stones (PIUS) based on a new scoring standard. The data of 90 patients with PIUS were collected in this retrospective study between January 2015 and June 2023. Univariate and multivariate logistic regression analyses were used to determine factors affecting treatment outcome in terms of SFR and complications. The scoring standard for patients with PIUS was developed based on the univariate logistic regression analyses. In the univariate analysis, stone density (P = 0.015), and stone diameter (P = 0.032) significantly were associated with lower SFR. And degree of hydronephrosis (P = 0.014), Preoperative infection (P = 0.002), and history of lithotripsy (P = 0.045) were associated with occurrence of complications. Multivariate analysis indicated that stone density (P = 0.020), and stone diameter (P < 0.001) were associated with lower SFR; independent risk factors for development of complications were history of lithotripsy (P = 0.024), and preoperative infection (P < 0.001). Additionally, score ≥ 3 was the independent risk factor for both SFR (P < 0.001) and complication rate (P < 0.001). Subgroup analysis shown that there were statistically significant differences between the two groups in terms of stone-free rate (P = 0.032) and complications (P = 0.015). According to the findings of this study, the stone score ≥ 3 was determined as a critical predictive factor of SFR and complications in PIUS patients undergoing PCN based on a new scoring standard. Additionally, PCN has high initial SFR and low complications when dealing with score < 3 PIUS.

Clinical Significance of Perinephric Fluid Collection in Patients with Renal Colic and Urolithiasis: A Retrospective Analysis

Background: Perinephric fluid is commonly identified in patients with renal colic and urolithiasis, especially in cases associated with hydronephrosis. However, its clinical relevance, particularly its impact on treatment decisions and prognosis, is not well established. Methods: This retrospective, single-center study included adult patients who presented to the emergency department (ED) with suspected renal colic between January 2021 and October 2023. Patients underwent ultrasound evaluations, which were analyzed for perinephric fluid, hydronephrosis, stone size, and stone location. Data on patient demographics, laboratory results, and clinical outcomes, including the need for urological interventions, were also collected and analyzed. Multivariate logistic regression was used to assess factors associated with perinephric fluid presence. Results: Of the 509 patients included, 200 (39.3%) had perinephric fluid. Hydronephrosis was significantly associated with perinephric fluid (OR: 4.14, p = 0.007), as were stones located in the proximal (OR: 3.06, p = 0.003) and distal ureter (OR: 2.31, p = 0.018). However, sonographic perinephric fluid did not significantly affect the likelihood of urological intervention, in-hospital complications, sepsis, acute kidney injury (AKI), acute kidney disease (AKD), and prolonged hospital stay. Conclusions: Perinephric fluid is a common finding in patients with renal colic and urolithiasis, particularly in cases involving hydronephrosis and ureteral stones. However, despite its prevalence, sonographic perinephric fluid was not significantly associated with the need for urological intervention, longer hospital stays, or worse clinical outcomes. Further prospective studies are required to clarify its clinical implications fully.

Microchannel percutaneous nephrolithotomy versus flexible ureteroscopic lithotripsy for the treatment of 1-2cm high hardness single upper ureteral stones: a propensity score-matched study.

The objective of this study was to compare the clinical efficacy and safety of microchannel percutaneous nephrolithotripsy (MPCNL) with flexible ureteroscopic lithotripsy (FURL) in the treatment of single upper ureteral stones with a diameter of 1-2cm and high hardness. This study retrospectively analyzed 89 patients diagnosed with a single upper ureteral stone with a 1-2cm diameter and a computed tomography value > 1000 Hounsfield units. A propensity score matching system matched this study with factors to minimize the effect of baseline differences between patients. Ultimately, 29 patients in each of the two groups were successfully matched. The stone-free rate was marginally higher in the MPCNL group than in the FURL group (93.10% vs. 86.21%), although the difference did not reach statistical significance (P = 0.666). Furthermore, the mean operative time in the MPCNL group, although slightly longer than that in the FURL group, did not demonstrate a statistically significant difference (P = 0.833). However, patients in the MPCNL group exhibited a significantly more substantial decrease in hemoglobin than those in the FURL group (P < 0.001) and a substantially more extended postoperative hospital stay (P < 0.001). Regarding perioperative complications, the incidence of moderate pain was higher in the MPCNL group than in the FURL group (P = 0.037). The difference in overall complication rates between the two groups did not reach statistical significance (P = 0.108). MPCNL and FURL are efficacious surgical procedures for treating single upper ureteral stones with a 1-2cm diameter and high hardness.

Effect of preoperative Silodosin on facilitating access sheath placement in retrograde intrarenal surgery. A randomized controlled studys

ABSTRACT Introduction to evaluate the effect of preoperative Silodosin on ureteric dilatation to facilitate ureteral access sheath (UAS) placement and reduction of ureteral wall injury in retrograde intrarenal surgery (RIRS). Methods one hundred and twenty patients with renal or ureteric stones were randomly allocated into 2 equal groups. Group A represents patients who received a 7-day preoperative single dose Silodosin before RIRS while Group B represents patients who received a placebo for the same regimen. Our primary outcome was to assess the success rate of (UAS) placement. Our secondary outcomes were to evaluate the perioperative complication rate, stone-free rate, hospital stay, and cost analysis. Results In our study, Silodosin showed a higher success rate for (UAS) insertion compared to placebo with a statistically significant difference (p-value = 0.04). Spontaneous UAS insertion in the Silodosin group was 58.3%, which was increased with active ureteric dilatation to 98.3%. Preoperative Silodosin led to less postoperative pain and analgesics requirements without impacting postoperative hospital stay or stone-free rate. There was less ureteric injury incidence in the Silodosin group compared to placebo with a statistically significant difference (p-value = 0.002). Conclusion Preoperative Silodosin facilitates UAS insertion with a protective role against ureteric injury compared to placebo.

Development and validation of a predictive model for failure of ureteral access sheath placement in patients with ureteral calculi

ObjectiveThe Ureteral Access Sheath (UAS) has notable benefits but may fail to traverse the ureter in some cases. Our objective was to develop and validate a dynamic online nomogram for patients with ureteral stones who experienced UAS placement failure during retrograde intrarenal surgery (RIRS).MethodsThis study is a retrospective cohort analysis using medical records from the Second Hospital of Tianjin Medical University. We reviewed the records of patients with ureteral stones who underwent RIRS in 2022 to identify risk factors associated with UAS placement failure. Lasso combined logistic regression was utilized to identify independent risk factors associated with unsuccessful UAS placement in individuals with ureteral stones. Subsequently, a nomogram model was developed to predict the likelihood of failed UAS placement in this patient cohort. The model’s performance was assessed through Receiver Operating Characteristic Curve (ROC) analysis, calibration curve assessment, and Decision Curve Analysis (DCA).ResultsSignificant independent risk factors for unsuccessful UAS placement in patients with ureteral stones included age (OR = 0.95, P < 0.001), male gender (OR = 2.15, P = 0.017), body mass index (BMI) (OR = 1.12, P < 0.001), history of stone evacuation (OR = 0.35, P = 0.014), and ureteral stone diameter (OR = 0.23, P < 0.001). A nomogram was constructed based on these variables. Model validation demonstrated an area under the ROC curve of 0.789, indicating good discrimination. The calibration curve exhibited strong agreement, and the decision curve analysis revealed a favorable net clinical benefit for the model.ConclusionsYoung age, male sex, high BMI, no history of stone evacuation, and small diameter of ureteral stones were independent risk factors for failure of UAS placement in patients with ureteral stones, and the dynamic nomogram established with these 5 factors was clinically effective in predicting the outcome of UAS placement.

Decision regret analysis in early URSL vs medical expulsive therapy 1 for ureteric calculi ≤ 1cm

BackgroundThe study assesses the decisional regret following Shared Decision-making (SDM) in patients selecting either early ureteroscopic lithotripsy (URSL) or medical expulsive therapy (MET) for ureteric stones ≤ 1 cm, with the aim to evaluate their decisional Conflict, satisfaction, and regret regarding their opted treatment choices.MethodsAdults aged more than 18 years with one stone up to 1 cm in either ureter were included. After SDM, the patients were allocated into their opted group viz. URSL or MET. Patients in each group were reassessed at “treatment completion”. Cambridge Ureteric Stone PROM (CUSP) questionnaire for HRQoL, Decision Regret Scale and the OPTION scale (SDM) were filled at treatment completion.Findings111 patients opted for MET, while 396 patients opted for early URSL. Mean stone size was larger in URSL group (7.16 ± 1.63 mm vs. 5.50 ± 1.89; p < 0.001). Decisional conflict was higher in patients opting for URSL (77.3% vs. 57.7%; p < 0.001). Stone-free rate at four weeks was higher in URSL group (87.1%vs68.5%, p < 0.001). Decisional regret was higher in patients opting for MET (33.24 ± 30.89 vs. 17.26 ± 12.92; p = 0.002). Anxiety, was higher in patients opting for MET (6.94 ± 1.89 vs. 5.85 ± 1.54; p < 0.001). Urinary symptoms and interference in patients’ travel plans and work-related activities were more in URSL group (6.21 ± 1.57 vs. 5.59 ± 1.46; p < 0.001 and 6.56 ± 1.59 vs. 6.05 ± 1.72; p < 0.001 respectively).InterpretationAfter SDM, decisional regret is higher in patients opting for MET mainly due protracted treatment duration with increased pain and anxiety during the treatment course and the need for additional procedure for attaining stone clearance and the. Despite higher decisional conflict, a larger proportion of patients opt for early URSL with the aim of avoiding anxiety and achieving early stone clearance.

Surgical management of obstructing ureteral stones during pregnancy: A systematic review of different techniques.

Renal colic is the most common non-obstetric cause of abdominal pain during pregnancy and is associated with a higher risk of complications in these women. When invasive treatment is required, options are temporary drainage with ureteral stent (JJ) or percutaneous nephrostomy (PCN), or immediate definitive treatment with ureteroscopy (URS). Our goal was to review the safety and efficacy of these procedures in treating urolithiasis during pregnancy. Adhering to the PRISMA checklist guidelines, we searched PubMed, Embase, and Scopus databases for articles on the efficacy and complications of the three procedures in pregnant women. The quality of evidence and risk of bias were evaluated using the Critical Appraisal Skills Programme and the Institute of Health Economics tools. We included 45 articles, totaling 3424 interventions in pregnant women - 2188 URS, 719 JJ, and 517 PCN. URS was the most assessed procedure, with stone-free rates comparable to the non-pregnant patients. The most frequent complications were lower urinary symptoms and infections independently of the intervention. Obstetric complications for all interventions included 167 cases of preterm labor, resulting in 24 premature births. No statistically significant differences in post-operative complications were reported between the procedures in the few comparative studies. Despite the absence of high-quality studies, current evidence suggests that URS, JJ, and PCN are all safe and effective during pregnancy. As most patients submitted to temporary drainage require a second procedure post-delivery, primary URS appears more efficient. Therefore, it is the preferred option unless there are indications for temporary drainage.

Break Wave Lithotripsy for Urolithiasis: Results of the First-in-Human International Multi-Institutional Clinical Trial.

This study reports on a prospective, multicenter, single-arm, clinical trial utilizing the SonoMotion (San Mateo, California) Break Wave lithotripsy (BWL) device to fragment urinary stones. Patients with a urinary stone underwent a single treatment of 30 minutes and peak negative pressure of 4.5 to 8 MPa. Subjects were contacted and outcomes assessed at 7, 14, and 35 days after treatment, with clinical follow-up and CT imaging 70 ± 14 days postprocedure. The primary objectives were to assess the safety (hematomas, complications, etc) and effectiveness of BWL (any fragmentation, residual fragments ≤4 mm or ≤2 mm, and completely stone-free rate) as assessed via noncontrast CT-kidneys, ureters, and bladder. Forty-four patients with a ureteral (43%) or renal (57%) stone were treated across 5 centers. Stone fragmentation occurred in 88% of cases; 70% had fragments ≤ 4 and 51% ≤ 2 mm, while 49% were completely stone free on CT; no serious adverse events were reported. Eighty-six percent of patients received either no analgesic medication at all (50%) or minor analgesia (36%). After determining optimal therapy settings, 36 patients were treated and the effectiveness improved exhibiting fragmentation in 92% (33/36), residual fragments ≤ 4 mm in 75% and 58% with fragments ≤ 2 mm with 58% completely stone free. Effectiveness was less in subjects with lower pole stones with 81% fragmentation, 71% having fragments ≤ 4 mm, 29% with fragments ≤ 2 mm, and 29% completely stone free; of distal ureteral stone patients, 89% were completely stone free. BWL offered safe and effective noninvasive stone therapy requiring little to no anesthesia and was carried out successfully in nonoperative environments. ClinicalTrials.gov identifier: NCT03811171.

Efficacy of Low-Dose Deflazacort with Tamsulosin in the Medical Expulsive Therapy of Distal Ureterolithiasis: A Randomized Controlled Trial

Introduction: Distal ureterolithiasis, characterized by stones in the lower ureter, poses significant challenges in clinical management. Medical expulsive therapy (MET) using Tamsulosin is a common non-invasive treatment, but its efficacy can be limited, especially for stones larger than 5 mm. Deflazacort, a corticosteroid with anti-inflammatory properties, may enhance the effectiveness of Tamsulosin by reducing ureteral inflammation and facilitating stone passage. Methods: This prospective, randomized controlled trial enrolled 80 patients with distal ureteral stones &lt;8 mm. Participants were randomly assigned to receive either Tamsulosin alone or Tamsulosin with Deflazacort for 28 days. Primary outcomes included stone expulsion rate and time, while secondary outcomes were pain reduction, analgesic use, and adverse effects. Results: The combination therapy group showed a higher expulsion rate (85% vs. 70%) and significantly faster expulsion time (10.1 days vs. 13.9 days, p=0.006). Pain reduction was greater in the Deflazacort group, with fewer colic episodes and reduced analgesic requirements. Adverse effects were comparable between the groups, with no significant increase in major side effects in the combination therapy group. Conclusion: The addition of low-dose Deflazacort to Tamsulosin significantly improves stone expulsion rates, reduces expulsion time, and lowers pain levels in patients with distal ureterolithiasis, without increasing major adverse effects. This combination may represent a superior treatment option in MET for distal ureteral stones.