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Introduction Atazanavir, an anti‐HIV drug, induces urinary stone formation. We herein report a case of atazanavir‐induced bilateral ureteral stones treated with endourological procedures. Case presentation A 47‐year‐old male patient on atazanavir was admitted with right flank pain. The patient's serum creatinine level was 3.60 mg/dL. Plain computed tomography showed bilateral hydronephrosis. The left upper ureter was obstructed by a 13 × 12 × 9‐mm mass, which had very low CT attenuation values. The lower part of the right ureter was obstructed, but no mass was observed. Given his medical history, we suspected bilateral ureteral obstruction caused by drug‐induced stones. A ureteral stent was successfully inserted on the right side, but not on the left side. Thereafter, a bilateral ureteroscopic lithotripsy was performed. Infrared spectrophotometry revealed that the stone component was atazanavir. Conclusion Understanding the characteristics of these rare drug‐induced stones will aid in the proper early diagnosis and treatment.

Abstract Background This study investigated the relaxation effect of PGE2 on the ureter and its role in promoting calculi expulsion following calculi development. Methods By using immunofluorescence and Western blot, we were able to locate EP receptors in the ureter. In vitro experiments assessed the impact of PGE2, receptor antagonists, and agonists on ureteral relaxation rate. We constructed a model of ureteral calculi with flowable resin and collected ureteral tissue from postoperative side of the ureter after obstruction surgery. Western blot analysis was used to determine the protein expression levels of EP receptors and the PGE2 terminal synthase mPGES-1. Additionally, PGE2 was added to smooth muscle cells to observe downstream cAMP and PKA changes. Results The expression of EP2 and EP4 proteins in ureteral smooth muscle was verified by Western blot analysis. According to immunofluorescence, EP2 was primarily found on the cell membrane, while EP4 was found in the nucleus. In vitro, PGE2 induced concentration-dependent ureteral relaxation. Maximum diastolic rate was 70.94 ± 4.57% at a concentration of 30µM. EP2 antagonists hindered this effect, while EP4 antagonists did not. Obstructed ureters exhibited elevated mPGES-1 and EP2 protein expression (P

Introduction: The presence of ureteral stones can cause pain, infections of urinary tract and hydronephrosis, resulting in the loss of renal function. For two decades, Ureteroscopy and laser stone fragmentation (URSL) attained a big rise and is the first line management for large ureteric stones and renal stones up to 2 cm. The present study was conducted to assess the success rate of ureteroscopic lithotripsy in treatment of ureteric calculus after local administration of aminophylline. Materials and methods: 100 patients having ureteric calculi <20 mm in size, aged 20–60 years were included in the study and randomly divided into Group A (n = 50) with administration of local aminophylline and Group B (n = 50) with administration of saline infusion. Ureteroscopy was performed after 5 min of administration of the solution. URSL was done using pneumatic lithoclast and/or laser. Various parameters like duration of procedure, ease of ureteral access, requirement of DJ Stent and need of further operative interventions were compared between case and control groups. The data was collected and then subjected to statistical analysis using IBM SPSS 20.0 version at significance level of p < 0.05. Results: The mean age of study subjects having ureteral stones was found to be between 31 and 40 years of age with males being more affected. We observed less mean duration of surgery, higher success rate, easy ureteral access (p -value < 0.05) with aminophylline use than control group. The need of ureteral stent and Auxiliary procedures was significantly higher in the control than in the case group (38%). Conclusion: The use of aminophylline has been found to be highly useful and effective in reducing the need of stents and secondary surgery, decreased pain, and increased success rate. Thus, the use of aminophylline is recommended during URSL procedure for the successful management of ureteral calculi. [ABSTRACT FROM AUTHOR]

Background: Ureteral calculi larger than ten millimeters are likely to impact and have high endoscopic failure rates, suggesting a good indication for primary ureterolithotomy. Aim: This study aimed to assess the results of laparoscopic ureterolithotomy and extracorporeal shock wave lithotripsy (ESWL) in management of large Ureteral Calculi as regards the morbidity and stone free rate. Patients and methods: This prospective randomized research has been performed on 48 cases with large ureteral calculi divided into 2 groups: Group A involved 24 cases that underwent laparoscopic ureterolithotomy and Group B involved the remaining 24 cases that underwent ESWL. The patients were collected from the Outpatient Urology Clinic in Suez Canal University Hospital in Ismailia and from the National Institute of Urology in Cairo from November 2014 till November 2016. Results: After the procedure, statistically insignificant variance was observed among both studied groups regarding fever (p-value equal 0.074) and hematuria. However, the incidence of residual stone significantly increased with ESWL (33.33% vs. 4.2% in laparoscopy - p = 0.01). No mortality was encountered in our study. In the laparoscopic group, transformation to the open technique has been required in three patients (12.5%), and postoperative leakage ranged between 0 and 1600 ml. 1 case had persistent leakage and required DJ stent. Conclusion: Laparoscopy is superior to ESWL in single-session clearance of ureteric stones. Nonetheless, it is associated with longer procedure time, longer hospitalization period, and postoperative urine leakage. [ABSTRACT FROM AUTHOR]

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

INTRODUCTION: To evaluate the clinical characteristics as well as the postoperative course of urolithiasis patients undergoing a ureteroscopy (URS) without stent placement. MATERIALS AND METHODS: This was a prospective case cohort study utilizing data collected in the Registry for Stones of the Kidney and Ureter (ReSKU) from a single institution between October 2015 and December 2020. We identified all consecutive patients undergoing URS for stone disease and analyzed data encompassing demographics, medical history, intra and postoperative characteristics, including complications and postoperative symptoms. Univariate and multivariate logistic regression analyses were performed based on the presence or absence of an indwelling ureteral stent. RESULTS: A total of 470 patients were included for analysis, 92 patients in the stentless group (19.5%). Factors associated with stentless ureteroscopy were a lower stone burden (p < 0.001), the pre-existence of a ureteral stent (37.4% vs. 27.9% p = 0.011), absence of an access sheath (14.6% vs. 69.5% p < 0.001), and a shorter operative time (31 vs. 58 min p < 0.001). Postoperative gross hematuria and lower urinary tract symptoms (LUTS) were reported less frequently in stentless patients (p = 0.02, p = 0.01, respectively). There was no difference in postoperative complications between both groups (15.2% vs. 12.0%, p = 0.385). On multivariate analysis, the risk of postoperative complications was associated with obesity, stone burden ≥ 1 cm, and positive preoperative urine culture. There was no patient who required emergent stent placement in the stentless group. CONCLUSION: Our data show that, in well selected patients, omitting ureteral stent placement after URS can decrease postoperative gross hematuria and LUTS without increasing postoperative complications.

Introduction Renal pseudoaneurysms reportedly occur after partial nephrectomy, renal trauma, or percutaneous procedures. Renal pseudoaneurysms can also occur after renal inflammation; however, such cases are rare and seldom reported. Case presentation A 53‐year‐old man presented to our emergency room with a 3‐day history of fever and right back pain. A blood sample revealed severe inflammation and computed tomography showed an 8 mm diameter stone in the right middle ureter and hydronephrosis. The patient was diagnosed with calculous pyelonephritis and underwent emergency ureteral stenting and antibiotic therapy. On day 8 of hospitalization, hematuria and right back pain developed, and on day 9 bladder tamponade and anemia developed. Contrast‐enhanced computed tomography revealed a ruptured pseudoaneurysm, and the patient underwent successful angioembolization. The patient was discharged on day 23. Conclusion We report a case of a renal pseudoaneurysm possibly caused by calculous pyelonephritis.

In order to explore the therapeutic effect of holmium laser and pneumatic lithotripsy on ureteric stones, as well as their effects on stress status and renal function, 100 patients with ureteral calculi admitted to the hospital from January 2021 to January 2023 were selected into a pneumatic lithotripsy group (n = 50) and a holmium laser lithotripsy group (n = 50). The results showed that Holmium laser lithotripsy had a significantly higher primary lithotripsy success rate (92.00%) than pneumatic lithotripsy (76.00%) (p < 0.05). However, a slightly higher postoperative stone clearance rate was observed in the pneumatic lithotripsy group with no significant differences between both groups. Significantly shorter operation time and average hospital stays were observed in the holmium laser lithotripsy group than in the pneumatic lithotripsy group. 3 days after surgery, C-reactive protein (CRP) and interleukin-6 (IL-6) levels in the holmium laser lithotripsy group were evidently lower than the pneumatic lithotripsy group. Holmium laser lithotripsy produced significantly lower malondialdehyde (MDA) levels (p < 0.05) and significantly higher superoxide dismutase (SOD) levels than pneumatic lithotripsy (p < 0.05). Both groups had similar preoperative renal function indexes (serum creatinine (Scr) and blood urea nitrogen (BUN)) (p > 0.05). Lastly, holmium laser lithotripsy had a considerably lower incidence of complications at 6.00% than pneumatic lithotripsy at 26.00% (p < 0.05). The results indicate that, compared with pneumatic ballistic lithotripsy, holmium laser lithotripsy can effectively improve the lithotripsy effect of ureteral stones, shorten the operation and hospitalization time, effectively reduce the inflammatory and oxidative stress status of the body, and effectively reduce the risk of postoperative complications.

Purpose: To evaluate whether computer program-estimated urolith stone volume (SV) was a better predictor of spontaneous passage (SP) compared with program-estimated stone diameter (PD) or manually measured stone diameter (MD), and whether utilizing SV and MD together provided additional value in SP prediction compared with MD alone. Materials and Methods: Retrospective analysis of patients with acute renal colic and single renal/ureteral stone on CT from July 2017 to April 2020. Diameter obtained from radiology reports or manually measured when report not available. Semiautomated stone analysis software (qSAS) was used to estimate SV and PD. ROC analysis was performed to compare accuracy of SV vs MD vs PD in predicting SP by 2, 4, and 6 weeks. Subgroup analysis was performed by stone size (

Introduction In this study we aimed to compare the efficacy of mirabegron and silodosin as medical expulsive therapy (MET) for distal ureteric calculus ≤10 mm. Material and methods A total of 114 patients who met the inclusion criteria were prospectively randomised into 2 groups, 58 patients in the silodosin group and 56 patients in the mirabegron group. The drugs were given for a maximum of 4 weeks. The primary endpoint was the stone expulsion rate, and secondary endpoints were stone expulsion time and number of pain episodes. Results There were no statistically significant differences between the two groups in terms of mean age, gender, mean stone size, side, or hydronephrosis. Both groups exhibited similar rates of stone expulsion and expulsion time. Regarding pain management, the frequency of renal colic episodes was significantly lower with mirabegron compared to silodosin (2.3 ±0.2 vs 1.9 ±0.2, P <0.0001). Six patients were excluded from the study due to adverse drug reactions: 4 (6.15%) in the silodosin group (retrograde ejaculation, hypotension) and 2 (3.27%) in the mirabegron group (hypertension). Conclusions In among patients with distal ureteric stones measuring 5–10 mm, mirabegron did not demonstrate superiority in stone expulsion rate or expulsion time compared to silodosin. However, mirabegron significantly reduced the frequency of renal colic episodes. Therefore, mirabegron may be considered a preferable option for medical expulsive therapy for distal ureter stones over silodosin. [ABSTRACT FROM AUTHOR]

Background: There is a need to reliably render urolithiasis patients completely stone free with minimal morbidity. We report on the initial safety and feasibility with steerable ureteroscopic renal evacuation (SURE) in a prospective study using basket extraction as a comparison. Materials and Methods: A pilot randomized controlled study was conducted comparing SURE with basket extraction postlaser lithotripsy. SURE is performed using the CVAC™ Aspiration System, a steerable catheter (with introducer). The safety and feasibility of steering CVAC throughout the collecting system under fluoroscopy and aspirating stone fragments as it was designed to do were evaluated. Fluoroscopy time, change in hemoglobin, adverse events through 30 days, total and proportion of stone volume removed at 1 day, intraoperative stone removal rate, and stone-free rate (SFR) at 30 days through CT were compared. Results: Seventeen patients were treated (n = 9 SURE, n = 8 Basket). Baseline demographics and stone parameters were not significantly different between groups. One adverse event occurred in each group (self-limiting ileus for SURE and urinary tract infection for Basket). No mucosal injury and no contrast extravasation were observed in either group. The CVAC catheter was steered throughout the collecting system and aspirated fragments. There was no significant difference in fluoroscopy time, procedure time, change in hemoglobin, or stone removal rate between groups. SURE removed more and a greater proportion of stone volume at day 1 vs baskets (202 mm3 vs 91 mm3, p

Recently，the incidence of ureteral calculi has been increased，and the treatment methods have been constantly updated. Nowadays，minimally invasive treatment has become a trend，mainly including extracorporeal shockwave lithotripsy（ESWL），ureteroscopic lithotripsy（URL），percutaneous nephrolithotripsis（PCNL）and laparoscopic lithotripsis. Noncontrast computed tomography（NCCT），as a common noninvasive diagnostic technique for clinical surgical diseases，has high specificity and sensitivity for the identification of ureteral calculi. In addition to definite diagnosis，the use of ureteral wall thickness（UWT）measurement to predict the matching degree of ureteral calculi treatment and prognosis has received widespread attention. Existing literature has suggested that UWT can predict the efficacy of ureteral stone incarceration and treatment plan. However，most studies are limited to the prediction of single treatment mode by UWT. In this article，literature review related to UWT was performed，aiming to provide reference for the prediction of ureteral stone incarceration and the selection of clinical treatment regimen.

Background The management of patients with ureteral calculi in the emergency department (ED) remains challenging due to high revisit rates. Purpose To identify predictors of revisits among patients with ureteral calculi in the ED. Design, setting, and participants Data from patients who presented at a tertiary academic hospital in Seoul, Republic of Korea, between February 2018 and December 2019, were analyzed retrospectively. Outcome measurements and statistical analysis Variables, including the respiratory rate (RR), estimated glomerular fltration rate (eGFR), duration of pain, number of analgesic doses, location of ureteral calculi, and ED length of stay (LOS) were examined using logistic regression. We also examined some additional variables included in the STONE and CHOKAI scoring systems to examine their association with revisit. Results Signifcant predictors of revisits included the number of analgesic doses and the location of ureteral calculi. Patients who required multiple analgesic doses or those with proximal or mid-ureteral calculi were more likely to revisit the ED. Although the STONE and CHOKAI scores could predict uncomplicated ureteral calculi, we found that the CHOKAI score is a valuable tool for predicting the likelihood of patient revisits (p=0.021). Conclusions Efective pain management and consideration of calculi location are important for predicting patient revisits. More research is required to validate fndings, develop precise predictive models, and empower tailored care for high-risk patients. Patient summary In patients with ureteral calculi in the ED, the number of analgesics given and stone location predict return visits. Proximal ureteral calculi on CT may require early urologic intervention to prevent pain-related revisits. [ABSTRACT FROM AUTHOR]

Recently, the incidence of ureteral calculi has been increased, and the treatment methods have been constantly updated. Nowadays, minimally invasive treatment has become a trend, mainly including extracorporeal shockwave lithotripsy （ESWL）, ureteroscopic lithotripsy (URL), percutaneous nephrolithotripsis (PCNL) and laparoscopic lithotripsis. Noncontrast computed tomography （NCCT）, as a common noninvasive diagnostic technique for clinical surgical diseases, has high specificity and sensitivity for the identification of ureteral calculi. In addition to definite diagnosis, the use of ureteral wall thickness （UWT） measurement to predict the matching degree of ureteral calculi treatment and prognosis has received widespread attention. Existing literature has suggested that UWT can predict the efficacy of ureteral stone incarceration and treatment plan. However, most studies are limited to the prediction of single treatment mode by UWT. In this article, literature review related to UWT was performed, aiming to provide reference for the prediction of ureteral stone incarceration and the selection of clinical treatment regimen. [ABSTRACT FROM AUTHOR]

Introduction We aim to review the outcomes of shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotripsy (PCNL) for renal and ureteral stones in spinal cord neuropathy patients (SNP). Material and methods A literature search was performed on 8th March 2023 using PubMed, EMBASE, and Google Scholar with no date limit. Preclinical/animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Only English papers were accepted. Results Thirty-five articles were accepted. Five studies focused on SWL, 17 on PCNL, and 6 on ureteroscopy. The remaining articles employed more than one procedure. Stone composition has shifted from struvite to the more common calcium phosphate. SWL showed a very poor stone-free rate (SFR) likely due to challenges in patient positioning, stone visualization, localization, and inability to pass fragments spontaneously. Flexible ureteroscopy and PCNL were associated with a high incidence of infectious complications, long hospital stays, high blood transfusion rate, and intensive care admissions. There were also cases of death. Both procedures were challenging due to genitourinary reconstruction, scoliosis and kyphosis, rib-cage deformity, lower limb contractures, and severe comorbidity which also affected anesthesia. SFR was lower than in non-neurological patients. Conclusions SWL, ureterolithotripsy, and PCNL should be considered challenging procedures in SNP due to positioning issues, an increased risk of intra and peri-operative morbidity, and even mortality. Computed tomography should be recommended to assess residual fragments as it becomes imperative to minimize a re-intervention in SNP who should be preferably treated in referral centers. [ABSTRACT FROM AUTHOR]