objective:To assess the utility of trans-vaginal ultrasonography in evaluation of non-pregnant sexually active female patients with lower ureteric calculi.Methods:A prospective study was done from January 2015 to Dece...objective:To assess the utility of trans-vaginal ultrasonography in evaluation of non-pregnant sexually active female patients with lower ureteric calculi.Methods:A prospective study was done from January 2015 to December 2017 including non-pregnant sexually active females with suspected ureteric calculus.Trans-abdominal ultrasound was initially done in all patients.In those patients in whom trans-abdominal ultrasound was inconclusive or there was indirect evidence of lower ureteric calculus in form of ureteral dila-tion but no calculus was evident,trans-vaginal ultrasound was done.The patients with ureteric calculi detected on trans-vaginal ultrasound and kept on conservative management were also followed up with trans-vaginal ultrasound.Non-contrast computed tomography was done in patients with inconclusive trans-vaginal ultrasound.Results:As per the study protocol,156 out of the total 468 patients evaluated by trans-abdominal ultrasound were eligible for trans-vaginal ultrasound.Trans-vaginal ultrasound was done in 149 patients,as seven patients did not give consent.Seventy-nine patients were detected with a lower ureteric calculus on trans-vaginal ultrasound and 27 patients had gyne-cologic or other cause for their symptoms.Forty-three patients had an inconclusive trans-vaginal ultrasound of which 36 underwent non-contrast computed tomography,among them only one patient had a lower ureteric calculus.Stone free status could be easily demonstrated on follow-up trans-vaginal ultrasound.展开更多
Spontaneous rupture of the ureter is a very interesting and unusual phenomenon which normally occurs due to ureteral obstruction.We present a case of spontaneous rupture of the distal ureter,secondary to a ureteric ca...Spontaneous rupture of the ureter is a very interesting and unusual phenomenon which normally occurs due to ureteral obstruction.We present a case of spontaneous rupture of the distal ureter,secondary to a ureteric calculus.Our patient presented with a history of acute on chronic abdominal pain and was septic on arrival to hospital.展开更多
Current minimally invasive interventions for ureteric stones involve either ESWL or Ureteroscopy and stone localization is mandatory for successful treatment in both. Objectives: To avoid doing KUB radiograph before E...Current minimally invasive interventions for ureteric stones involve either ESWL or Ureteroscopy and stone localization is mandatory for successful treatment in both. Objectives: To avoid doing KUB radiograph before ESWL routinely by correlating the stone attenuation value on CT KUB with stone visualization at fluoroscopy. Methods: This is a prospective cross sectional hospital based, Multicentric study carried out on 1010 patients with ureteric stones in Sudan from August 2014 to March 2016. Results: Mean stone density in HU was 704.45 ± 300 (SD) ranging (81 - 1873) HU. All of the stones were localized using fluoroscopy and only 26.5% of them were not seen under fluoroscopy. I.V contrast was used mostly, and also mainly in the upper ureter. More than 80% of the application of contrast through the ureteric catheter was in the lower ureteric stones. 91.2% of patients with stone density ≤ 400 HU failed to appear at fluoroscopy and therefore 400 HU attenuation value can be used as a cut-off level to request doing KUB before ESWL and Ureteroscopy. Conclusion: the ureteric stones with density ≤400 HU the likelihood of being non-visualized at fluoroscopy is 91.2% therefore if the stone has ≤400 HU at CT KUB it is mandatory to do KUB before treatment above that it is most likely to be seen at fluoroscopy and no need to request KUB for them before ESWL or URS. 1) Inclusion Criteria: All patients diagnosed by CT scan to have ureteric stones for ESWL or Ureteroscopy. 2) Exclusion Criteria: Patients for whom treatment of ureteric stone by ESWL or ureteroscopy is not indicated like severe infection or poor kidney function where nephrectomy is needed.展开更多
AIM: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function.METHODS: All 285 recipients of kidney transplantation...AIM: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function.METHODS: All 285 recipients of kidney transplantation at our centre between 2006 and 2010 were included in the study. Detailed information including stent use and transplant function was collected prospectively and analysed retrospectively. The diagnosis of urinary tract infection was made on the basis of compatible symptoms supported by urinalysis and/or microbiological culture. Graft function, estimated glomerular filtration rate and creatinine at 6 mo and 12 mo, immediate graft function and infection rates were compared between those with a stent or without a stent.RESULTS: Overall, 196(183 during initial procedure, 13 at reoperation) patients were stented following transplantation. The overall urine leak rate was 4.3%(12/277) with no difference between those with or without stents- 7/183 vs 5/102, P = 0.746. Overall, 54%(99/183) of stented patients developed a urological infection compared to 38.1%(32/84) of those without stents(P = 0.0151). All 18 major urological infections occurred in those with stents. The use of stent(Wald χ2 = 5.505, P = 0.019) and diabetes mellitus(Wald χ2 = 5.197, P = 0.023) were found to have significant influence on urological infection rates on multivariate analysis. There were no deaths or graft losses due to infection. Stenting was associated with poorer transplant function at 12 mo.CONCLUSION: Stents increase the risks of urological infections and have a detrimental effect on early to medium term renal transplant function.展开更多
The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL. Methods: A total of 417 patients harboring renal or ureteral stones underwent extracorporeal shock wave...The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL. Methods: A total of 417 patients harboring renal or ureteral stones underwent extracorporeal shock wave lithotripsy (ESWL) between October 2008 and July 2012. Eighty five patients were lost on follow up. The remaining (n = 332). All patients were >18 yr of age. Siemens and SLX-F2 electromagnetic machines were used to impart shock waves. Patients were stratified according to localization (pelvic, calyceal, or ureteral stones) and stone size (up to 10 mm, 10 - 20 mm, and >20 mm). Result: The overall success rate was 251/332 (75.6%) achieve stone free status. Repeated ESWL sessions were needed in 258 (61.9%). Of eleven variables were studied including age, sex, side, location (pelvic, calyx, ureter), ureteric stent, previous renal surgery, stone size, number of shock waves, opacity of stone, renal system state, and type of lithotripter, three variables were significantly affect the success rate namely stone size, number of shock waves and location of stone. Conclusions: ESWL remains one of the most commonly utilized treatments for patients with upper urinary tract calculi;Stone diameter, location, and number of shock waves, are the most important predictors determining stone clearance after ESWL of renal and ureteric calculi. To optimize treatment outcomes with ESWL the presence of treating urologist is essential to optimize the final result.展开更多
Objective:To determine the diagnostic value of ultrasound signs of urinary stones less than or equal to 10 mm and to determine clinico-radiological variants of ureteric colic.Methods:A total of 455 ultrasound investig...Objective:To determine the diagnostic value of ultrasound signs of urinary stones less than or equal to 10 mm and to determine clinico-radiological variants of ureteric colic.Methods:A total of 455 ultrasound investigations were performed in patients referring to emergency department with urolithiasis and symptoms suspected of ureteric colic between January 2021 and May 2021.In addition to microscopic evaluation of urine sediment to detect different crystals and non-contrast spiral computed tomography to detect stones,B-mode and color Doppler sonography was performed to assess the presence of acoustic shadow(AS)and twinkle artifacts(TA)as possible signs of stone(s)in ureter.Results:While the sensitivity and specificity of AS and TA were higher than 90%in patients with stones greater than 5 mm;positive prognostic values of these parameters were found to be extremely low for stones with sizes of 1-3 mm with specificity and sensitivity values not exceeding 53%.The sensitivity and specificity of AS and TA in the upper and lower ureters were higher for stones greater than or equal to 5 than for compared to those less than 5 mm.At the same time,the diagnostic values of TA and AS for middle ureter stones were very limited.The most prevalent clinico-radiological variants of ureteric colic were types I,III,and V being observed in 39%,28% and 21% cases,respectively.Conclusion:Our results demonstrate that TA and AS parameters seem to have a very low sensitivity and specificity in the diagnosis of urinary stones less than 5 mm.The diagnostic value of TA and AS increase significantly in stones greater than or equal to 5 mm.Therefore,clinicians need to be very careful for overestimating the diagnostic values of TA and AS for stones less than 5 mm and non-contrast spiral computed tomography must be the method of choice for patients presenting to emergency department with ureteric colic.展开更多
Background: Stone disease is a wide health problem;certain drugs have been used as supplement with ESWL for the treatment of symptomatic uncomplicated lower ureteric stone like Nefidipine, Alfuzosin and Tamsulosin. Th...Background: Stone disease is a wide health problem;certain drugs have been used as supplement with ESWL for the treatment of symptomatic uncomplicated lower ureteric stone like Nefidipine, Alfuzosin and Tamsulosin. The purpose of this study is to evaluate the efficacy of Tamsulosin for the treatment of lower ureteric stone of 5 - 10 mm diameter after ESWL. Methods: A total of 105 patients with lower ureteric stone of less than 10 mm diameters were divided into two groups. Group 1 including 48 patients received 0.4 mg Tamsulosin and diclofenac sodium analgesia as needed immediately after ESWL and continued until stone expulsion was confirmed up to maximum of 30 days. Group 2 including 47 patients was given diclofenac sodium only as needed after ESWL. Result: 46 of 49 patients in group 1 and 44 of 48 patients in group 2 ultimately passed stones. The number of ESWL sessions was 1.4 ± 0.6 in group 1 & 1.42 ± 0.75 in group 2. There were 10 patients who needed analgesia after ESWL in group 1 and 17 patients in group 2. Visual analogue scale pain severity score was 5.32 ± 1.23 and 6.41 ± 1.26 in group 1 and 2, respectively. The time to stone expulsion in group 1 and 2 was 8 ± 5.4 days and 12 ± 10.3 days, respectively. No significant complications or side effects occurred. Conclusion: The use of Tamsulosin in combination with ESWL in patients with lower ureteric stone of 5 - 10 mm was effective for reducing the time to stone expulsion, decreasing need for analgesia, and facilitating stone passage without significant improvement in stone free rate.展开更多
Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not ...Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone;2) Group 2: including 60 patients with distal ureteric stone. Preoperatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.展开更多
Background: Incomplete ureteric duplication can be associated with either ureteropelvic obstruction involving the lower moiety or reflux between the ureters (yo-yo reflux). Yo-yo reflux can be a cause of repeated urin...Background: Incomplete ureteric duplication can be associated with either ureteropelvic obstruction involving the lower moiety or reflux between the ureters (yo-yo reflux). Yo-yo reflux can be a cause of repeated urinary tract infection with subsequent renal damage. Aim of the work: The current study evaluated the presence of yo-yo reflux as reason of upper moiety dilation in cases with incomplete duplication of upper urinary tract. Methodology: 10 cases with a dilated upper moiety of duplex renal pelvicalyceal system were examined with color duplex ultrasonography. All were further investigated with intravenous pyelography (IVP), and ascending/micturating cystography. Results: 9 cases with upper moiety dilation showed complete duplication of the pelvicalyceal systems and ureters and 1 case with dilated upper moiety showed incomplete ureteric duplication in which the diagnosis of Yo-yo reflux was confirmed by color duplex ultrasound in addition to the intravenous pyelography findings. Conclusion: The presence of antegrade/retrograde flow within the dilated moiety of a duplex kidney during color duplex study in addition to the intravenous pyelography findings can confirm the diagnosis of yo-yo reflux.展开更多
Background: Bladder exstrophy is a rare congenital malformation of the genitourinary system, with an estimated incidence of approximately 1 per 50,000 live births. Clinically, patients do not have capacity to accumula...Background: Bladder exstrophy is a rare congenital malformation of the genitourinary system, with an estimated incidence of approximately 1 per 50,000 live births. Clinically, patients do not have capacity to accumulate urine and urine continously leak. We present patient with partial storing capacity from the dialated distal ureters. A case of dialated distal ureters from an 8-year-old female patient with ectopic vesicae is described. The dialated ureters act as reservoir of urine where the patient is partially continent in the night time. These dialated ureters are the compensation for the literally absent bladder. During reconstruction, we observed that they can be used as an additional bladder volume reducing risk of reconstruction failure from tension.展开更多
Objective: The objective is to assess the benefits and adverse effects of routine ureteral stenting after uncomplicated ureteroscopic lithotripsy. Material and Methods: Sixty patients with ureteric calculi amenable to...Objective: The objective is to assess the benefits and adverse effects of routine ureteral stenting after uncomplicated ureteroscopic lithotripsy. Material and Methods: Sixty patients with ureteric calculi amenable to ureteroscopic lithotripsy were randomized to an unstented (30 patients) or a stented (30 patients) treatment group, standard ureteroscopic lithotripsy done using 8 French semirigid ureteroscope, and pneumatic lithotripter used to fragment the stones. They were followed up for postoperative flank pain, lower urinary tract symptoms (LUTS) and hematuria. Results: There was no significant difference in the mean age (stenting 37.8 year and 33.5 year unstenting) of patients, gender and stone size in both groups. No significant difference in the mean flank pain within 3 days postoperative, while at day 14 postoperative flank pain for stenting group was significant (P = 0.03). Dysuria and urgency were high for stenting group (P = 0.002 and 0.011). Hematuria within 3 and 14 days was higher in the stenting group. Conclusion: After uncomplicated ureteroscopy, stents can be safely omitted. Unstented patients have significantly fewer LUTS, haematuria and flank pain.展开更多
OBJECTIVE:To investigate the effeicacy of Yishen Huoxue decoction(YSHX)on renal fibrosis induced by unilateral ureteric obstruction(UUO),and on reactive oxygen species(ROS)homeostasis in human umbilical vein endotheli...OBJECTIVE:To investigate the effeicacy of Yishen Huoxue decoction(YSHX)on renal fibrosis induced by unilateral ureteric obstruction(UUO),and on reactive oxygen species(ROS)homeostasis in human umbilical vein endothelial cells(HUVECs).METHODS:Forty male mice were randomly divided into six groups,sham group,UUO group,UUO+resveratrol(RSV)(15 mg/kg)group,UUO+YSHX20 mg/kg group(UUO+YSHX-L),UUO+YSHX 40 mg/kg group(UUO+YSHX-M),UUO+YSHX 80 mg/kg group(UUO+YSHX-H).Western blotting was used to measure protein expression levels.Reverse transcription-quantitative polymerase chain reaction was used to measure the m RNA expression.Immunohistochemistry was used to examine the histopathological changes of kidney tissue sample.Cell apoptosis was measured by Annexin V/PI staining.Cell viability was measured using CCK-8/WST-8 assay.RESULTS:YSHX treatment reducedα-SMA and Col-4 expressions,and increased CD31 and VE-cadherin expressions in UUO model mice.In vitro,YSHX increased cell viability and decreased apoptosis of HUVECs under hypoxic conditions.YSHX inhibited ROS generation by activating adenosine monophosphate-activated protein kinase(AMPK)/peroxisome proliferator-activated receptor coactivator-1α(PGC-1α)/silent mating-type information regulation2 homolog 3(Sirt3)signaling.CONCLUSION:YSHX treatment reduced 109 KJ UUO-induced renal injury and fibrosis.Furthermore,YSHX treatment attenuated hypoxia-induced oxidative stress by regulating AMPK/PGC-1α/Sirt3 signaling.展开更多
Aim: To study the advantage of excision of the distal symptomatic ureteric stumps with the retroperitoneal laparo-scopic approach. Methods: Four patients who had failed to settle their symptoms with the initial conser...Aim: To study the advantage of excision of the distal symptomatic ureteric stumps with the retroperitoneal laparo-scopic approach. Methods: Four patients who had failed to settle their symptoms with the initial conservative man-agement were included in the study. All underwent excision of the distal symptomatic ureteric stumps with the retroperi-toneal laparoscopic approach and then received prophylactic antibiotics. Results: We have achieved better resultsthan those reported in the literature in terms of operating time (mean 1 h 45 min), blood loss ( < 10 mL), postopera-tive recovery (within 12 h) and hospital stay ( < 48 h). Conclusion; Retroperitoneal laparoscopic excision is asafe, simple and effective method in the management of symptomatic ureteric stumps.展开更多
Dear editor,“Ureteric stump syndrome(USS)”is a rare entity(incidence 0.8%–1.0%)with left-over in situ distal-ureter being the culprit[[1],[2],[3]].The presentation may be recurrent urinary tract infection(UTI),flan...Dear editor,“Ureteric stump syndrome(USS)”is a rare entity(incidence 0.8%–1.0%)with left-over in situ distal-ureter being the culprit[[1],[2],[3]].The presentation may be recurrent urinary tract infection(UTI),flank/abdominal pain,or hematuria[1,4].Although only few of the patients require intervention(approximately 1.1%–10%)[[1],[2],[3]],either with open excision of the stump[[1],[2],[3]]or via minimally invasive endoscopic approach[5,6],prompt diagnosis is often delayed.During simple nephrectomy,dilemma exists whether to consider concomitant total ureterectomy to eliminate the future risk of USS[4],or to consider subtotal-ureterectomy along with nephrectomy[[1],[2],[3]].In this letter,we present a retrospective analysis of clinical presentation,diagnostic approach,and management of three patients of USS(Table 1)treated at our centre and try to solve all these dilemmas.展开更多
Background:The use of tamsulosin before semirigid ureteroscopy(URS)for proximal ureteral stones increases operative success.Several authors have usedα-blockers for dilation of the ureter,andmost studies have observed...Background:The use of tamsulosin before semirigid ureteroscopy(URS)for proximal ureteral stones increases operative success.Several authors have usedα-blockers for dilation of the ureter,andmost studies have observed a higher stone-free rate and fewer complications than those with a placebo or no use of drugs.Ureteroscopy is the standard treatment for ureteral stones and has excellent outcomes.This study aimed to assess the effect of preoperative tamsulosin on the intraoperative and postoperative outcomes of URS in the management of lower ureteric stones.Materials and methods:This was a double-blind randomized placebo-controlled clinical trial.A total of 80 patients were included,40 in each group.The closed envelope method of randomization was performed at the Assiut Urology and Nephrology Hospital(Urology Department),Faculty of Medicine,Assiut University,Egypt,from December 2019 to November 2021.Results:Both groups showed no significant differences in age,and themajority of patients in both groups weremale.Most patients had a moderate degree of obstruction,and the stones were radiopaque.Both groups showed insignificant differences in stone size(11.93±3.39 vs.12.40±4.24 mm,p=0.30).Operative time was significantly shorter in the study group than in the control group(61.50±23.99 vs.79.80±23.22 minutes,p=0.001).The control group had a significantly higher frequency of need for dilatation(80%vs.20%,p<0.001)and need to stent than the study group(60%vs.22.5%,p=0.001).Conclusions:Preoperative tamsulosin facilitates URS for lower ureteric stones.It decreases operative time,the need for dilation,and the need for postoperative indwelling ureteral stenting.It also increases the success rate but does not significantly affect the complication rate.展开更多
Introduction:Distal ureteral obstruction has classically been managed by ureteroneocystostomy(UNC).The feasibility and success of robotic primary ureteroureterostomy(UU)for benign obstruction appears promising with se...Introduction:Distal ureteral obstruction has classically been managed by ureteroneocystostomy(UNC).The feasibility and success of robotic primary ureteroureterostomy(UU)for benign obstruction appears promising with several benefits over UNC but is poorly studied.Robotic repair offers superior visualization and precision,allowing for minimal ureteral dissection.Here we report on our experience and short-term outcomes.Materials and Methods:We identified patients who underwent robotic distal ureteroureterostomy for benign distal ureteral obstruction at our institution from 2020–2024.Etiology,stricture length,and post-operative outcomes were recorded.All patients had renal ultrasound(US),diuretic renography,or cross-sectional imaging within 6 months of repair.Results:Seven patients underwent distal UU from 2020–2024,with one case of bilateral repair for a total of 8 anastomoses.Iatrogenic injury from hysterectomy represented 5/8 injuries.The mean time between injury and repair was 3.5 months.All defects were 1–1.5 cm in length.At follow-up imaging,there was no evidence of obstruction in any patient with a median follow-up of 10 months,including diuretic renography in 5 of 7 patients.One patient had mild hydronephrosis on their initial renal US but with normal drainage on subsequent diuretic renography.All patients reported no flank pain at follow-up.Conclusions:Robotic UU is feasible for short,benign distal ureteral obstruction in carefully selected patients.Advantages over traditional UNC include a significantly shorter catheter time,no risk of vesicoureteral reflux,no effect on bladder capacity or function,and the ability to retain the native ureteral orifice.Continued research will elucidate the long-term efficacy of this approach.展开更多
Malignant ureteral obstruction may lead to renal function damage,renal colic,and infection.The impact of obstructive development on ureteral peristalsis was rarely studied,which requires further investigation.This stu...Malignant ureteral obstruction may lead to renal function damage,renal colic,and infection.The impact of obstructive development on ureteral peristalsis was rarely studied,which requires further investigation.This study used theoretical biomechanical methods to study the motion characteristics of the ureteral wall and obtained the radial motion equation of the ureteral wall.The motion equation was solved by 4-5th order Runge Kutta method.Analyze the motion equation of the ureteral wall,derive the expression for malignant obstructive ureteral pressure,as well as the analytical expressions for radial displacement and circumferential stress of the ureteral wall.By analyzing the radial motion equation of the ureter,it can be found that peristalsis is influenced by the pressure difference between inside and outside.The analytical solutions for radial displacement and stress contained exponential terms.Under the condition of 50%obstruction,the displacement and stress of the ureter were reduced by 90.53%and 81.10%,respectively.This study established the radial motion equation of the ureter and provided analytical solutions for the radial displacement and stress of the obstructed ureter.Based on the radial motion equation of the ureter,the radial motion characteristics of the ureteral wall were explored,including peristalsis and disappearance of peristalsis.This study provided a quantitative relationship between ureteral obstruction and peristalsis.As the degree of obstruction increased,ureteral peristalsis gradually weakened or even disappeared.展开更多
Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and ...Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and combination therapy with tamsulosin,silodosin,and tadalafil on stone expulsion rate(SER)and stone expulsion time(SET),as well as their comparative safety,numbers of colic pain episodes,and need for analgesics.Methods:Randomized controlled trials were retrieved by searching PubMed,Scopus,and Web of Science up to November 27,2023.Hand-searching was also conducted in Google Scholar to find additional records.Papers in English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones≤10 mm were included.Results:In total,27 studies were identified(six studies through database searches and 21 through checking reference lists and hand-searching in Google Scholar).More than half of them(n=15,56%)were conducted in India.The SER significantly improved with silodosin compared with tamsulosin(odds ratio[OR]2.24,p<0.001),whereas the difference in SET was non-significant.Tadalafil achieved a significantly higher SER compared with tamsulosin(OR 1.42,p=0.042)without any difference in SET.Subgroup analysis of 5-and 10-mg doses of tadalafil showed no significant difference in SER or SET.We found no significant difference in need for analgesics(mean difference(MD−53.73,p=0.2)or the mean number of colic episodes(MD−0.42,p=0.060)between tadalafil and tamsulosin.SER or SET was not significantly different between silodosin and tadalafil.Tadalafil plus tamsulosin led to a significantly higher SER(OR 1.87,p<0.001)and SET(MD−2.99,p=0.002)compared with tamsulosin,without any significant difference in adverse effects.Conclusion:Compared with tamsulosin,SER significantly improved with silodosin,tadalafil,and the combination of tadalafil plus tamsulosin.Meanwhile,the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin.It appears that tadalafil and silodosin have similar efficacy in SET and SER.All medical expulsive therapies had comparable safety.展开更多
Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergen...Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergent,unscheduled care.This study assessed the impact of stent duration,sex,and other patient-associated factors on reported pain scores using a large,international prospective registry.Methods:A prospective observational patient registry on ureteral stents from 10 institutions in 4 countries(United States,Canada,France,and Japan)from 2020–2023 was assessed.The primary outcome was Patient-Reported Outcomes Measurement Information System(PROMIS)pain intensity scores administered on the day of stent removal,before stent removal.Patients were grouped by indwelling time(short,medium,and long),and pain scores were compared.The impact of sex,height vs.stent length,and presence or absence of tether were assessed.Results:359 patients were enrolled in the database,with outcomes analyzed for 268 patients with a unilateral stent placed after an endourologic procedure for stones.No significant difference was detected in pain scores between the indwelling time groups(p=0.41).Height for a given stent length was not significantly associated with pain scores.There was no difference in pain scores with or without tether.Men reported lower pain scores than women(p=0.018).Conclusions:This study did not detect an overall difference in pain scores reported at stent removal within or between stent duration groups.Men reported less pain than women in this study,suggesting that patient factors may be more important than indwelling time when optimizing pain management.展开更多
Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral...Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.展开更多
文摘objective:To assess the utility of trans-vaginal ultrasonography in evaluation of non-pregnant sexually active female patients with lower ureteric calculi.Methods:A prospective study was done from January 2015 to December 2017 including non-pregnant sexually active females with suspected ureteric calculus.Trans-abdominal ultrasound was initially done in all patients.In those patients in whom trans-abdominal ultrasound was inconclusive or there was indirect evidence of lower ureteric calculus in form of ureteral dila-tion but no calculus was evident,trans-vaginal ultrasound was done.The patients with ureteric calculi detected on trans-vaginal ultrasound and kept on conservative management were also followed up with trans-vaginal ultrasound.Non-contrast computed tomography was done in patients with inconclusive trans-vaginal ultrasound.Results:As per the study protocol,156 out of the total 468 patients evaluated by trans-abdominal ultrasound were eligible for trans-vaginal ultrasound.Trans-vaginal ultrasound was done in 149 patients,as seven patients did not give consent.Seventy-nine patients were detected with a lower ureteric calculus on trans-vaginal ultrasound and 27 patients had gyne-cologic or other cause for their symptoms.Forty-three patients had an inconclusive trans-vaginal ultrasound of which 36 underwent non-contrast computed tomography,among them only one patient had a lower ureteric calculus.Stone free status could be easily demonstrated on follow-up trans-vaginal ultrasound.
文摘Spontaneous rupture of the ureter is a very interesting and unusual phenomenon which normally occurs due to ureteral obstruction.We present a case of spontaneous rupture of the distal ureter,secondary to a ureteric calculus.Our patient presented with a history of acute on chronic abdominal pain and was septic on arrival to hospital.
文摘Current minimally invasive interventions for ureteric stones involve either ESWL or Ureteroscopy and stone localization is mandatory for successful treatment in both. Objectives: To avoid doing KUB radiograph before ESWL routinely by correlating the stone attenuation value on CT KUB with stone visualization at fluoroscopy. Methods: This is a prospective cross sectional hospital based, Multicentric study carried out on 1010 patients with ureteric stones in Sudan from August 2014 to March 2016. Results: Mean stone density in HU was 704.45 ± 300 (SD) ranging (81 - 1873) HU. All of the stones were localized using fluoroscopy and only 26.5% of them were not seen under fluoroscopy. I.V contrast was used mostly, and also mainly in the upper ureter. More than 80% of the application of contrast through the ureteric catheter was in the lower ureteric stones. 91.2% of patients with stone density ≤ 400 HU failed to appear at fluoroscopy and therefore 400 HU attenuation value can be used as a cut-off level to request doing KUB before ESWL and Ureteroscopy. Conclusion: the ureteric stones with density ≤400 HU the likelihood of being non-visualized at fluoroscopy is 91.2% therefore if the stone has ≤400 HU at CT KUB it is mandatory to do KUB before treatment above that it is most likely to be seen at fluoroscopy and no need to request KUB for them before ESWL or URS. 1) Inclusion Criteria: All patients diagnosed by CT scan to have ureteric stones for ESWL or Ureteroscopy. 2) Exclusion Criteria: Patients for whom treatment of ureteric stone by ESWL or ureteroscopy is not indicated like severe infection or poor kidney function where nephrectomy is needed.
文摘AIM: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function.METHODS: All 285 recipients of kidney transplantation at our centre between 2006 and 2010 were included in the study. Detailed information including stent use and transplant function was collected prospectively and analysed retrospectively. The diagnosis of urinary tract infection was made on the basis of compatible symptoms supported by urinalysis and/or microbiological culture. Graft function, estimated glomerular filtration rate and creatinine at 6 mo and 12 mo, immediate graft function and infection rates were compared between those with a stent or without a stent.RESULTS: Overall, 196(183 during initial procedure, 13 at reoperation) patients were stented following transplantation. The overall urine leak rate was 4.3%(12/277) with no difference between those with or without stents- 7/183 vs 5/102, P = 0.746. Overall, 54%(99/183) of stented patients developed a urological infection compared to 38.1%(32/84) of those without stents(P = 0.0151). All 18 major urological infections occurred in those with stents. The use of stent(Wald χ2 = 5.505, P = 0.019) and diabetes mellitus(Wald χ2 = 5.197, P = 0.023) were found to have significant influence on urological infection rates on multivariate analysis. There were no deaths or graft losses due to infection. Stenting was associated with poorer transplant function at 12 mo.CONCLUSION: Stents increase the risks of urological infections and have a detrimental effect on early to medium term renal transplant function.
文摘The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL. Methods: A total of 417 patients harboring renal or ureteral stones underwent extracorporeal shock wave lithotripsy (ESWL) between October 2008 and July 2012. Eighty five patients were lost on follow up. The remaining (n = 332). All patients were >18 yr of age. Siemens and SLX-F2 electromagnetic machines were used to impart shock waves. Patients were stratified according to localization (pelvic, calyceal, or ureteral stones) and stone size (up to 10 mm, 10 - 20 mm, and >20 mm). Result: The overall success rate was 251/332 (75.6%) achieve stone free status. Repeated ESWL sessions were needed in 258 (61.9%). Of eleven variables were studied including age, sex, side, location (pelvic, calyx, ureter), ureteric stent, previous renal surgery, stone size, number of shock waves, opacity of stone, renal system state, and type of lithotripter, three variables were significantly affect the success rate namely stone size, number of shock waves and location of stone. Conclusions: ESWL remains one of the most commonly utilized treatments for patients with upper urinary tract calculi;Stone diameter, location, and number of shock waves, are the most important predictors determining stone clearance after ESWL of renal and ureteric calculi. To optimize treatment outcomes with ESWL the presence of treating urologist is essential to optimize the final result.
文摘Objective:To determine the diagnostic value of ultrasound signs of urinary stones less than or equal to 10 mm and to determine clinico-radiological variants of ureteric colic.Methods:A total of 455 ultrasound investigations were performed in patients referring to emergency department with urolithiasis and symptoms suspected of ureteric colic between January 2021 and May 2021.In addition to microscopic evaluation of urine sediment to detect different crystals and non-contrast spiral computed tomography to detect stones,B-mode and color Doppler sonography was performed to assess the presence of acoustic shadow(AS)and twinkle artifacts(TA)as possible signs of stone(s)in ureter.Results:While the sensitivity and specificity of AS and TA were higher than 90%in patients with stones greater than 5 mm;positive prognostic values of these parameters were found to be extremely low for stones with sizes of 1-3 mm with specificity and sensitivity values not exceeding 53%.The sensitivity and specificity of AS and TA in the upper and lower ureters were higher for stones greater than or equal to 5 than for compared to those less than 5 mm.At the same time,the diagnostic values of TA and AS for middle ureter stones were very limited.The most prevalent clinico-radiological variants of ureteric colic were types I,III,and V being observed in 39%,28% and 21% cases,respectively.Conclusion:Our results demonstrate that TA and AS parameters seem to have a very low sensitivity and specificity in the diagnosis of urinary stones less than 5 mm.The diagnostic value of TA and AS increase significantly in stones greater than or equal to 5 mm.Therefore,clinicians need to be very careful for overestimating the diagnostic values of TA and AS for stones less than 5 mm and non-contrast spiral computed tomography must be the method of choice for patients presenting to emergency department with ureteric colic.
文摘Background: Stone disease is a wide health problem;certain drugs have been used as supplement with ESWL for the treatment of symptomatic uncomplicated lower ureteric stone like Nefidipine, Alfuzosin and Tamsulosin. The purpose of this study is to evaluate the efficacy of Tamsulosin for the treatment of lower ureteric stone of 5 - 10 mm diameter after ESWL. Methods: A total of 105 patients with lower ureteric stone of less than 10 mm diameters were divided into two groups. Group 1 including 48 patients received 0.4 mg Tamsulosin and diclofenac sodium analgesia as needed immediately after ESWL and continued until stone expulsion was confirmed up to maximum of 30 days. Group 2 including 47 patients was given diclofenac sodium only as needed after ESWL. Result: 46 of 49 patients in group 1 and 44 of 48 patients in group 2 ultimately passed stones. The number of ESWL sessions was 1.4 ± 0.6 in group 1 & 1.42 ± 0.75 in group 2. There were 10 patients who needed analgesia after ESWL in group 1 and 17 patients in group 2. Visual analogue scale pain severity score was 5.32 ± 1.23 and 6.41 ± 1.26 in group 1 and 2, respectively. The time to stone expulsion in group 1 and 2 was 8 ± 5.4 days and 12 ± 10.3 days, respectively. No significant complications or side effects occurred. Conclusion: The use of Tamsulosin in combination with ESWL in patients with lower ureteric stone of 5 - 10 mm was effective for reducing the time to stone expulsion, decreasing need for analgesia, and facilitating stone passage without significant improvement in stone free rate.
文摘Background: Extracorporeal shock wave lithotripsy (ESWL) became the first line in the treatment of ureteric stone after failure of conservative treatment because of its safety, simplicity and effectiveness. It is not invasive procedure and can be done on outpatient basis without anesthesia and with few complications which is most probably temporary and treatable. The objective of this study is to evaluate the efficiency and safety of ESWL in treatment of ureteric stone in Iraq. Materials and Methods: A total of 112 Iraqi patients with ureteric stones were participated in this prospective observational study in which patients scheduled for ESWL treatment for a period of 6 months. Patients were divided into 2 groups: 1) Group 1: 52 patients with proximal ureteric stone;2) Group 2: including 60 patients with distal ureteric stone. Preoperatively all patient underwent bowel preparation and were asked to fast for 8 hours before the procedure. Results: The age ranged between 22 and 55 with mean of 42 (SD = 5) years. Around 46% had proximal ureteric stone and the rest were in distal ureter. Around 44% needed one session and 40% needed two sessions to be stone-free respectively. In regards to associated symptoms, 74% had ureteric colic, 3% haematuria, 43% microhematuria and 12% UTI. Mild hydronephrosis was found in 90% of the cases and 30 reported had previous intervention. Success rate was 90%. Conclusions: ESWL is safe and effective in treatment of ureteric stone with few complications and must be regarded first choice after conservative treatment in a patient with uncomplicated ureteric stone.
文摘Background: Incomplete ureteric duplication can be associated with either ureteropelvic obstruction involving the lower moiety or reflux between the ureters (yo-yo reflux). Yo-yo reflux can be a cause of repeated urinary tract infection with subsequent renal damage. Aim of the work: The current study evaluated the presence of yo-yo reflux as reason of upper moiety dilation in cases with incomplete duplication of upper urinary tract. Methodology: 10 cases with a dilated upper moiety of duplex renal pelvicalyceal system were examined with color duplex ultrasonography. All were further investigated with intravenous pyelography (IVP), and ascending/micturating cystography. Results: 9 cases with upper moiety dilation showed complete duplication of the pelvicalyceal systems and ureters and 1 case with dilated upper moiety showed incomplete ureteric duplication in which the diagnosis of Yo-yo reflux was confirmed by color duplex ultrasound in addition to the intravenous pyelography findings. Conclusion: The presence of antegrade/retrograde flow within the dilated moiety of a duplex kidney during color duplex study in addition to the intravenous pyelography findings can confirm the diagnosis of yo-yo reflux.
文摘Background: Bladder exstrophy is a rare congenital malformation of the genitourinary system, with an estimated incidence of approximately 1 per 50,000 live births. Clinically, patients do not have capacity to accumulate urine and urine continously leak. We present patient with partial storing capacity from the dialated distal ureters. A case of dialated distal ureters from an 8-year-old female patient with ectopic vesicae is described. The dialated ureters act as reservoir of urine where the patient is partially continent in the night time. These dialated ureters are the compensation for the literally absent bladder. During reconstruction, we observed that they can be used as an additional bladder volume reducing risk of reconstruction failure from tension.
文摘Objective: The objective is to assess the benefits and adverse effects of routine ureteral stenting after uncomplicated ureteroscopic lithotripsy. Material and Methods: Sixty patients with ureteric calculi amenable to ureteroscopic lithotripsy were randomized to an unstented (30 patients) or a stented (30 patients) treatment group, standard ureteroscopic lithotripsy done using 8 French semirigid ureteroscope, and pneumatic lithotripter used to fragment the stones. They were followed up for postoperative flank pain, lower urinary tract symptoms (LUTS) and hematuria. Results: There was no significant difference in the mean age (stenting 37.8 year and 33.5 year unstenting) of patients, gender and stone size in both groups. No significant difference in the mean flank pain within 3 days postoperative, while at day 14 postoperative flank pain for stenting group was significant (P = 0.03). Dysuria and urgency were high for stenting group (P = 0.002 and 0.011). Hematuria within 3 and 14 days was higher in the stenting group. Conclusion: After uncomplicated ureteroscopy, stents can be safely omitted. Unstented patients have significantly fewer LUTS, haematuria and flank pain.
基金Supported by National Natural Science Foundation of China:Study on the Treatment Mechanism of"Kidney Benefiting and Blood Circulation Activation"in Renal Fibrosis Based on SIRT3 Regulation AMPK/PCG-1/CPT1A Signaling Pathways(No.81760807)Study on the Anti-renal Fibrosis Mechanism of Yishen Huoxue Formula Based on the Regulation of Hypoxia-glycolysis Pathway by Exosome Derived Mir-210(No.82060820)。
文摘OBJECTIVE:To investigate the effeicacy of Yishen Huoxue decoction(YSHX)on renal fibrosis induced by unilateral ureteric obstruction(UUO),and on reactive oxygen species(ROS)homeostasis in human umbilical vein endothelial cells(HUVECs).METHODS:Forty male mice were randomly divided into six groups,sham group,UUO group,UUO+resveratrol(RSV)(15 mg/kg)group,UUO+YSHX20 mg/kg group(UUO+YSHX-L),UUO+YSHX 40 mg/kg group(UUO+YSHX-M),UUO+YSHX 80 mg/kg group(UUO+YSHX-H).Western blotting was used to measure protein expression levels.Reverse transcription-quantitative polymerase chain reaction was used to measure the m RNA expression.Immunohistochemistry was used to examine the histopathological changes of kidney tissue sample.Cell apoptosis was measured by Annexin V/PI staining.Cell viability was measured using CCK-8/WST-8 assay.RESULTS:YSHX treatment reducedα-SMA and Col-4 expressions,and increased CD31 and VE-cadherin expressions in UUO model mice.In vitro,YSHX increased cell viability and decreased apoptosis of HUVECs under hypoxic conditions.YSHX inhibited ROS generation by activating adenosine monophosphate-activated protein kinase(AMPK)/peroxisome proliferator-activated receptor coactivator-1α(PGC-1α)/silent mating-type information regulation2 homolog 3(Sirt3)signaling.CONCLUSION:YSHX treatment reduced 109 KJ UUO-induced renal injury and fibrosis.Furthermore,YSHX treatment attenuated hypoxia-induced oxidative stress by regulating AMPK/PGC-1α/Sirt3 signaling.
文摘Aim: To study the advantage of excision of the distal symptomatic ureteric stumps with the retroperitoneal laparo-scopic approach. Methods: Four patients who had failed to settle their symptoms with the initial conservative man-agement were included in the study. All underwent excision of the distal symptomatic ureteric stumps with the retroperi-toneal laparoscopic approach and then received prophylactic antibiotics. Results: We have achieved better resultsthan those reported in the literature in terms of operating time (mean 1 h 45 min), blood loss ( < 10 mL), postopera-tive recovery (within 12 h) and hospital stay ( < 48 h). Conclusion; Retroperitoneal laparoscopic excision is asafe, simple and effective method in the management of symptomatic ureteric stumps.
文摘Dear editor,“Ureteric stump syndrome(USS)”is a rare entity(incidence 0.8%–1.0%)with left-over in situ distal-ureter being the culprit[[1],[2],[3]].The presentation may be recurrent urinary tract infection(UTI),flank/abdominal pain,or hematuria[1,4].Although only few of the patients require intervention(approximately 1.1%–10%)[[1],[2],[3]],either with open excision of the stump[[1],[2],[3]]or via minimally invasive endoscopic approach[5,6],prompt diagnosis is often delayed.During simple nephrectomy,dilemma exists whether to consider concomitant total ureterectomy to eliminate the future risk of USS[4],or to consider subtotal-ureterectomy along with nephrectomy[[1],[2],[3]].In this letter,we present a retrospective analysis of clinical presentation,diagnostic approach,and management of three patients of USS(Table 1)treated at our centre and try to solve all these dilemmas.
文摘Background:The use of tamsulosin before semirigid ureteroscopy(URS)for proximal ureteral stones increases operative success.Several authors have usedα-blockers for dilation of the ureter,andmost studies have observed a higher stone-free rate and fewer complications than those with a placebo or no use of drugs.Ureteroscopy is the standard treatment for ureteral stones and has excellent outcomes.This study aimed to assess the effect of preoperative tamsulosin on the intraoperative and postoperative outcomes of URS in the management of lower ureteric stones.Materials and methods:This was a double-blind randomized placebo-controlled clinical trial.A total of 80 patients were included,40 in each group.The closed envelope method of randomization was performed at the Assiut Urology and Nephrology Hospital(Urology Department),Faculty of Medicine,Assiut University,Egypt,from December 2019 to November 2021.Results:Both groups showed no significant differences in age,and themajority of patients in both groups weremale.Most patients had a moderate degree of obstruction,and the stones were radiopaque.Both groups showed insignificant differences in stone size(11.93±3.39 vs.12.40±4.24 mm,p=0.30).Operative time was significantly shorter in the study group than in the control group(61.50±23.99 vs.79.80±23.22 minutes,p=0.001).The control group had a significantly higher frequency of need for dilatation(80%vs.20%,p<0.001)and need to stent than the study group(60%vs.22.5%,p=0.001).Conclusions:Preoperative tamsulosin facilitates URS for lower ureteric stones.It decreases operative time,the need for dilation,and the need for postoperative indwelling ureteral stenting.It also increases the success rate but does not significantly affect the complication rate.
文摘Introduction:Distal ureteral obstruction has classically been managed by ureteroneocystostomy(UNC).The feasibility and success of robotic primary ureteroureterostomy(UU)for benign obstruction appears promising with several benefits over UNC but is poorly studied.Robotic repair offers superior visualization and precision,allowing for minimal ureteral dissection.Here we report on our experience and short-term outcomes.Materials and Methods:We identified patients who underwent robotic distal ureteroureterostomy for benign distal ureteral obstruction at our institution from 2020–2024.Etiology,stricture length,and post-operative outcomes were recorded.All patients had renal ultrasound(US),diuretic renography,or cross-sectional imaging within 6 months of repair.Results:Seven patients underwent distal UU from 2020–2024,with one case of bilateral repair for a total of 8 anastomoses.Iatrogenic injury from hysterectomy represented 5/8 injuries.The mean time between injury and repair was 3.5 months.All defects were 1–1.5 cm in length.At follow-up imaging,there was no evidence of obstruction in any patient with a median follow-up of 10 months,including diuretic renography in 5 of 7 patients.One patient had mild hydronephrosis on their initial renal US but with normal drainage on subsequent diuretic renography.All patients reported no flank pain at follow-up.Conclusions:Robotic UU is feasible for short,benign distal ureteral obstruction in carefully selected patients.Advantages over traditional UNC include a significantly shorter catheter time,no risk of vesicoureteral reflux,no effect on bladder capacity or function,and the ability to retain the native ureteral orifice.Continued research will elucidate the long-term efficacy of this approach.
基金supported by the National Natural Science Foundation of China(Grant Nos.12172034,U20A20390,and 11827803)Beijing Municipal Natural Science Foundation(Grant No.7212205)+1 种基金the 111 project(Grant No.B13003)the Fundamental Research Funds for the Central Universities.
文摘Malignant ureteral obstruction may lead to renal function damage,renal colic,and infection.The impact of obstructive development on ureteral peristalsis was rarely studied,which requires further investigation.This study used theoretical biomechanical methods to study the motion characteristics of the ureteral wall and obtained the radial motion equation of the ureteral wall.The motion equation was solved by 4-5th order Runge Kutta method.Analyze the motion equation of the ureteral wall,derive the expression for malignant obstructive ureteral pressure,as well as the analytical expressions for radial displacement and circumferential stress of the ureteral wall.By analyzing the radial motion equation of the ureter,it can be found that peristalsis is influenced by the pressure difference between inside and outside.The analytical solutions for radial displacement and stress contained exponential terms.Under the condition of 50%obstruction,the displacement and stress of the ureter were reduced by 90.53%and 81.10%,respectively.This study established the radial motion equation of the ureter and provided analytical solutions for the radial displacement and stress of the obstructed ureter.Based on the radial motion equation of the ureter,the radial motion characteristics of the ureteral wall were explored,including peristalsis and disappearance of peristalsis.This study provided a quantitative relationship between ureteral obstruction and peristalsis.As the degree of obstruction increased,ureteral peristalsis gradually weakened or even disappeared.
文摘Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and combination therapy with tamsulosin,silodosin,and tadalafil on stone expulsion rate(SER)and stone expulsion time(SET),as well as their comparative safety,numbers of colic pain episodes,and need for analgesics.Methods:Randomized controlled trials were retrieved by searching PubMed,Scopus,and Web of Science up to November 27,2023.Hand-searching was also conducted in Google Scholar to find additional records.Papers in English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones≤10 mm were included.Results:In total,27 studies were identified(six studies through database searches and 21 through checking reference lists and hand-searching in Google Scholar).More than half of them(n=15,56%)were conducted in India.The SER significantly improved with silodosin compared with tamsulosin(odds ratio[OR]2.24,p<0.001),whereas the difference in SET was non-significant.Tadalafil achieved a significantly higher SER compared with tamsulosin(OR 1.42,p=0.042)without any difference in SET.Subgroup analysis of 5-and 10-mg doses of tadalafil showed no significant difference in SER or SET.We found no significant difference in need for analgesics(mean difference(MD−53.73,p=0.2)or the mean number of colic episodes(MD−0.42,p=0.060)between tadalafil and tamsulosin.SER or SET was not significantly different between silodosin and tadalafil.Tadalafil plus tamsulosin led to a significantly higher SER(OR 1.87,p<0.001)and SET(MD−2.99,p=0.002)compared with tamsulosin,without any significant difference in adverse effects.Conclusion:Compared with tamsulosin,SER significantly improved with silodosin,tadalafil,and the combination of tadalafil plus tamsulosin.Meanwhile,the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin.It appears that tadalafil and silodosin have similar efficacy in SET and SER.All medical expulsive therapies had comparable safety.
文摘Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergent,unscheduled care.This study assessed the impact of stent duration,sex,and other patient-associated factors on reported pain scores using a large,international prospective registry.Methods:A prospective observational patient registry on ureteral stents from 10 institutions in 4 countries(United States,Canada,France,and Japan)from 2020–2023 was assessed.The primary outcome was Patient-Reported Outcomes Measurement Information System(PROMIS)pain intensity scores administered on the day of stent removal,before stent removal.Patients were grouped by indwelling time(short,medium,and long),and pain scores were compared.The impact of sex,height vs.stent length,and presence or absence of tether were assessed.Results:359 patients were enrolled in the database,with outcomes analyzed for 268 patients with a unilateral stent placed after an endourologic procedure for stones.No significant difference was detected in pain scores between the indwelling time groups(p=0.41).Height for a given stent length was not significantly associated with pain scores.There was no difference in pain scores with or without tether.Men reported lower pain scores than women(p=0.018).Conclusions:This study did not detect an overall difference in pain scores reported at stent removal within or between stent duration groups.Men reported less pain than women in this study,suggesting that patient factors may be more important than indwelling time when optimizing pain management.
文摘Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.
