Search

Background: Renal forniceal rupture (FR) is a unique complication of obstructive uropathy. This study aimed to identify the predictors of FR among patients presenting with renal colic due to obstructing ureteral calculi. Materials and Methods: After obtaining ethics approval, electronic records of patients from three National Guard hospitals in Saudi Arabia were reviewed between 2016 and 2020 to identify patients who presented with renal colic and were diagnosed with FR due to obstructive ureteric stones (FR group). An equivalent number of consecutive patients presenting with renal colic due to obstructing ureteric stones without FR was selected as a control group (non-FR group). Patients were grouped according to age group (50 years), body mass index (BMI) class, gender, comorbidities, grade of hydronephrosis, location of the stone in the ureter, size of the stone (7 mm), and stone former status. Baseline patients’ and stone characteristics were compared, and a regression analysis was performed to identify predictors of FR. Results: A total of 50 patients with FR were identified, and a control group of 50 patients without FR were selected. The baseline patients’ and stone demographic characteristics in terms of age (P = 0.42), gender (P = 0.275), BMI (P = 0.672), comorbidity, grade of hydronephrosis (P = 0.201), and stone location (P = 0.639) were comparable between the FR group and the non-FR group. However, the stone size was statistically significant between both groups (P = 0.014). On multivariable analysis, it was found that the stone size was associated with a significantly higher increase in the incidence of FR (odds ratio [OR]: 6.5 [1.235–34.434]; P = 0.027). Furthermore, the age group between 30 and 40 years was potentially at a lower risk for FR (OR: 0.262 [0.069–0.999]; P = 0.049). Conclusion: This multicenter study showed that the stone size 3–7 mm had a six-fold increase in the chance of FR, and the age group between 30 and 40 years is potentially at a lower risk for FR.

Background: Renal forniceal rupture (FR) is a unique complication of obstructive uropathy. This study aimed to identify the predictors of FR among patients presenting with renal colic due to obstructing ureteral calculi. Materials and Methods: After obtaining ethics approval, electronic records of patients from three National Guard hospitals in Saudi Arabia were reviewed between 2016 and 2020 to identify patients who presented with renal colic and were diagnosed with FR due to obstructive ureteric stones (FR group). An equivalent number of consecutive patients presenting with renal colic due to obstructing ureteric stones without FR was selected as a control group (non-FR group). Patients were grouped according to age group (<30, 30-40, 41-50, and >50 years), body mass index (BMI) class, gender, comorbidities, grade of hydronephrosis, location of the stone in the ureter, size of the stone (<3 mm, 3-7 mm, and >7 mm), and stone former status. Baseline patients' and stone characteristics were compared, and a regression analysis was performed to identify predictors of FR. Results: A total of 50 patients with FR were identified, and a control group of 50 patients without FR were selected. The baseline patients' and stone demographic characteristics in terms of age (P = 0.42), gender (P = 0.275), BMI (P = 0.672), comorbidity, grade of hydronephrosis (P = 0.201), and stone location (P = 0.639) were comparable between the FR group and the non-FR group. However, the stone size was statistically significant between both groups (P = 0.014). On multivariable analysis, it was found that the stone size was associated with a significantly higher increase in the incidence of FR (odds ratio [OR]: 6.5 [1.235-34.434]; P = 0.027). Furthermore, the age group between 30 and 40 years was potentially at a lower risk for FR (OR: 0.262 [0.069-0.999]; P = 0.049). Conclusion: This multicenter study showed that the stone size 3-7 mm had a six-fold increase in the chance of FR, and the age group between 30 and 40 years is potentially at a lower risk for FR. [ABSTRACT FROM AUTHOR]

Introduction: Ureteric colic in pregnancy is one of the common non-obstetric reasons for emergency department visits. Ureteric calculi present a significant threat to maternal and fetal health and definitive management often becomes necessary. Our aim is to assess the safety and efficacy of ureteroscopic laser lithotripsy in the management of ureteric stones in pregnancy. Material and methods: This is a prospective observational study of 3 years carried at a tertiary referral center. It includes all pregnant patients who underwent ureteroscopic laser lithotripsy for ureteric stones. Results: A total of 29 pregnant patients underwent ureteroscopic laser lithotripsy at our center in 3 years. The mean age of patients was 33.5 ± 6.2 years, and the mean gestation age at the time of ureteroscopy was 23.34 ± 5.9 weeks. The average stone size was 8.3 ± 3.6 mm and was predominantly found in upper ureter (62%). The mean operative time was 31 ± 8.9 min, and the average laser energy spent was 4.3 ± 1.1 kJ/case. There was no major Intraoperative complication, and the average hospital stay was 2.5 ± 1.5 days. Complete stone clearance was achieved in 93.1% of cases. Conclusion: Ureteroscopic laser lithotripsy is safe and effective treatment of ureteric stones in terms of obstetric outcome and stone clearance in pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To determine the complications of ureteric stone treatment with semi-rigid uretero-renoscopy in accordance with the modified Clavien classification system. Method: The descriptive, prospective study was conducted at the Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, from June 30, 2020, to December 29, 2021, and comprised patients of either gender aged 18-70 years having ureteric stones. All patients were subjected to ureterorenoscopy using a semi-rigid ureteroscope under general anaesthesia. The patients were followed up for 2 months. All complications were noted and graded in line with the Modified Clavien Complication System. Ultrasound and X-ray were used to determine the stone-free rate. Data was analysed using SPSS 23. Results: Of the 414 patients, 304(73.4%) were males and 110(26.5%) were females. The overall mean age was 40.22±13.10 years. There were 106(25.6%) proximal, 134(32.3%) middle, and 174(42%) distal ureteric stones. Stent placement was done in 56(13.5%) cases. There were 260(62.8%) patients with no complication, 90(21.7%) with grade I complications, 34(8.2%) with grade II complications, 10(2.4%) with grade IIIa, 8(1.9%) with grade IIIb, and 12 (2.9%) with grade IVa complications. Conclusion: Uretero-renoscopy was found to be a safe procedure, as it had minimal associated complications with optimal stone clearance and great dexterity. The Modified Clavien classification system was found to be an easy way to classify surgical complications of uretero-renoscopy. Key Words: Ureteroscopy, Modified Clavien classification system, Ureteric calculi, ESWL.

Introduction: Medical Expulsive Therapy (MET) involves the utilisation of different drugs that act on the ureter through various mechanisms. Alpha-1 adrenoceptor and Phosphodiesterase (PDE) regulate ureteric motility thus combination of these drugs can increase the ureteric stone expulsion rate by complementing each other's actions. Aim: To assess the synergistic role of alpha-blocker and Tadalafil therapy in facilitating the spontaneous expulsion of distal ureteral stones. Materials and Methods: A prospective cohort study was conducted in the Department of Urology at a Tertiary Care Centre (NSCB Medical College) from April 2020 to January 2022. A total of 281 patients diagnosed with lower ureteric stones (5-10 mm) were divided into five study groups: Group A was treated with tamsulosin, group B with silodosin, group C with tadalafil alone, group D with tamsulosin and tadalafil, and group E treated with a combination of silodosin and tadalafil. Corticosteroid (deflazacort 6 mg) was also included in every group. All patients were reassessed after three weeks of treatment for stone expulsion rate, expulsion time, the number of hospital visits for pain, and adverse effects of drugs. The statistical data was analysed using Statistical Package for Social Sciences (SPSS) software (version 21.0, IBM Corp, USA). The Chi-square test and Analysis of Variance (ANOVA) test were used to determine the effect on stone expulsion rate and expulsion time. The confidence interval was 95%, and the significance level of the p-value was set <0.05. Results: The stone expulsion rates in group A, B, C, D, and E were 70.91%, 79.63%, 52.63%, 84.21%, and 86.20%, respectively, which was significant (p=0.00194). The mean time taken for stone expulsion in group A, B, C, D, and E were 8.95±1.73, 8.43±1.57, 9.86±1.90, 7.96±2.03, and 7.75±1.84 days (p=0.0001). Minor side effects were not significant, except for retrograde ejaculation in group B and E, and 22.8% of patients needed hospitalisation in group C (tadalafil alone). Conclusion: Combination therapy is safe, efficacious, and well-tolerated as MET for distal ureteric calculi in the 5-10 mm range, thereby avoiding surgical procedures and providing faster relief for the patients. [ABSTRACT FROM AUTHOR]

Introduction: Medical Expulsive Therapy (MET) involves the utilisation of different drugs that act on the ureter through various mechanisms. Alpha-1 adrenoceptor and Phosphodiesterase (PDE) regulate ureteric motility thus combination of these drugs can increase the ureteric stone expulsion rate by complementing each other’s actions. Aim: To assess the synergistic role of alpha-blocker and Tadalafil therapy in facilitating the spontaneous expulsion of distal ureteral stones. Materials and Methods: A prospective cohort study was conducted in the Department of Urology at a Tertiary Care Centre (NSCB Medical College) from April 2020 to January 2022. A total of 281 patients diagnosed with lower ureteric stones (5-10 mm) were divided into five study groups: Group A was treated with tamsulosin, group B with silodosin, group C with tadalafil alone, group D with tamsulosin and tadalafil, and group E treated with a combination of silodosin and tadalafil. Corticosteroid (deflazacort 6 mg) was also included in every group. All patients were reassessed after three weeks of treatment for stone expulsion rate, expulsion time, the number of hospital visits for pain, and adverse effects of drugs. The statistical data was analysed using Statistical Package for Social Sciences (SPSS) software (version 21.0, IBM Corp, USA). The Chi-square test and Analysis of Variance (ANOVA) test were used to determine the effect on stone expulsion rate and expulsion time. The confidence interval was 95%, and the significance level of the p-value was set

Objective: The aim of this study was to evaluate the outcome of using the semi-rigid ureteroscope and intracorporeal pneumatic lithotripsy on the impacted upper ureteric stones. Methods: This is a retrospective study on patients who underwent ureteroscopy with pneumatic lithoclast fragmentation at Hamdard University Hospital from May 2018 to December 2021. Patients with impacted upper ureteric calculi > 1 cm and having a prior extracorporeal shock wave lithotripsy or medical expulsive therapy of more than 4 weeks were included. Those with persistent pain were also included. Patients <13 years of age, having a distal obstruction, who are pregnant, having spinal deformity, having morbid obesity, or on aspirin were excluded. Results: Out of 72 patients, 53 (73.6%) were males, and the mean age was 39.57 ± 8.81 years. There was a single stone in 66 (91.6%) and multiple in 6 cases. The mean stone diameter was 1.12 ± 0.4 cm. The mean duration of surgery was 32.13 ± 9.71 minutes. The stone-free rate was 79.2% (n = 57), while it migrated in 15 (20.8%) patients which required additional extracorporeal shock wave lithotripsy sessions. A double-J stent insertion was done intraoperatively in 21 (29.1%) patients. No major operative or postoperative complications were observed. Conclusion: Semi-rigid ureteroscope with pneumatic lithotripsy in an experienced hand is still a safe and useful treatment modality for impacted upper ureteric stones with good clearance rates and minimal complications. [ABSTRACT FROM AUTHOR]

This clinical review on renal and ureteric stones discusses how stones form, the incidence, risks, and complications associated with calculi. It reflects on the management and treatment options available, and highlights the important contribution by nurses and those working in advanced clinical practice roles in using their knowledge and rational clinical decision making to ensure timely recognition, prompt investigation, management and ongoing health promotion. [ABSTRACT FROM AUTHOR]

Purpose: The use of various alpha-receptor antagonists (α-blocker) drugs as medical expulsive therapy (MET) for spontaneous clearance of ureteral calculi of various sizes has been extensive in the last decade by urologists across the world. Among all, α-blocker tamsulosin has been used widely. In contrast silodosin which is recently introduced in the market and more selective alpha-receptor antagonist and cardioselective drug but it has not been used widely as MET. In this study, silodosin (8 mg), tamsulosin (0.4 mg), and oral hydration therapy were compared in terms of efficacy and safety as MET in the management of ureteric stone along with rate of stone clearance, expulsion time, analgesic requirements, and adverse effects for treating ureteral stones size between ≥4 mm and ≤10 mm in diameter. Materials and Methods: Prospective randomized study was conducted between September 2018 and August 2020 with a total of 240 patients (80 patients in each arm) in tertiary care center of eastern India. First group received a single dose of silodosin (8 mg) daily, second group received a single dose of tamsulosin (0.4 mg) daily and third group received oral hydration therapy for 4 weeks. Results: There is no difference in the stone expulsion rate (SER), stone expulsion time (SET), and surgical intervention between tamsulosin, silodosin and oral hydration therapy group for ureteric stones ≤5 mm size. For ureteric stones of size 6 mm--10 mm, silodosin has better SER than tamsulosin with no difference in terms of SET. Analgesic requirement and pain episodes were more in the oral hydration group with no adverse effects (statistically significant). Conclusion: The proportion of passed-out stone was significantly higher among the patients treated with silodosin (65.0%) in comparison to other two groups (P < 0.05) with no difference in SET. [ABSTRACT FROM AUTHOR]

Background: To compare the treatment outcome of Silodosin alone and Silodosin with Tadalafil as a medical expulsive therapy (MET) of lower ureteric stone in western part of Rajasthan. Material And Methods: The study was conducted in a tertiary hospital of Dr. S.N. Medical College, Jodhpur over a period of 12 months (1st January, 2020 to 31st December, 2020). Out of 108 patients, 100 meet the inclusion criteria who were purposively assigned into 2 groups. 48 patients included in Silodosin alone group and 52 in Silodosin with Tadalafil group. Result: There was a significant higher stone expulsion rate in Silodosin with Tadalafil than Silodosin alone which was 88.46% vs75% respectively (P value 0.02). The mean stone expulsion time of Silodosin alone was14.33 (±3.1) days and Silodosin plus Tadalafil was 11.48(±2.3) days (P value 0.001). The episodes of pain in Silodosin alone were 0.7(±0.06) and 0.6(±0.2) in Silodosin with Tadalafil group that was statistically significant. Conclusion: The present study suggested that Silodosin with tadalafil combination therapy significantly increases ureteric stone expulsion rate and decreases the expulsion time and pain episodes than treatment with silodosin alone. [ABSTRACT FROM AUTHOR]

Introduction: Distal ureteric calculi remain a widely debated topic without clear consensus on expectant management. This systematic review aims to assess the placebo arms of RCTs to extrapolate data on the natural history of distal ureteral stones and ascertain the success rate of expectant management. Methods: A literature search was performed, and 3 reviewers used a predefined inclusion criterion to independently select articles for inclusion. A cumulative analysis was undertaken, and risk of bias assessed using the Cochrane tool. Results: Stone expulsion was recorded in 1,823/2,447 (74.5%) patients overall. The expulsion rate of study participants receiving placebo varied widely from 35.2 to 88.9%. The overall expulsion rate of stones ≤5 mm was 486/561 (87%) as opposed to 814/1,093 (75%) in stones >5 mm in size. Time to stone expulsion varied from 8.54 to 24.5 days. A re rate of 2% was reported. Conclusions: Spontaneous passage of distal ureteric calculi is dependent on stone size and location within the ureter. Provided a patient does not portray symptoms of uncontrollable pain, infection, obstruction, or declining renal function, it is reasonable to trial a period of expectant management. Follow-up should be arranged to ensure symptom resolution, and alternative treatment can be offered if required. [ABSTRACT FROM AUTHOR]

Ureteric calculi are a common cause of emergency presentation to hospitals in the United Kingdom and worldwide. A significant and life threatening complication of those stones that obstruct the ureter is pyonephrosis, bacteraemia and resulting sepsis. Whilst the majority of such cases present with the typical symptoms of loin pain and fever, here we describe the case of a 57 year old patient with asymptomatic bilateral obstructing ureteric calculi that led to bacteraemia from a rare bacterial pathogen, Lactobacillus jensenii, and subsequent severe bacterial endocarditis requiring emergency aortic valve replacement.

Managing patient having multiple large ureteric calculi at different locations in ureter with minimal invasive surgery is always a challenge for the surgeon. We hereby present the case report of ureteroscopy assisted laparoscopic ureterolithotomy for multiple large ureteric calculi in proximal and distal ureter in a young female. In this unique and novel method ureteroscopy and laparoscopy was done simultaneously over the patient using two camera units and two surgeons. This approach avoided open ureterolithotomy scar and also extensive dissection of ureter. This unique surgery can be considered as confluence of endourology and laparoscopy.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8th December 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8th December 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic. [ABSTRACT FROM AUTHOR]

Abstract Objective Although medical expulsive therapy (MET) is shown to be effective for ureteric calculi, the optimum duration and the stone size suitable for MET are not well established yet. The objectives of the study were to determine the optimum duration and maximum stone size suitable for MET. Results All patients with radiologically confirmed uncomplicated ureteric calculi treated with MET using tamsulosin over a period of 6 months in the outpatient setting were followed up. There were 213 patients. 165 were men. Mean age was 42 years. At presentation 42 stones were in upper ureter (19.7%), 51 in mid ureter (23.9%), 120 in lower ureter (56.3%). The majority (82.7%) of stones were less than 10 mm. Seven stones (3.3%) were over 15 mm. Ninety-two (43.2%) patients had spontaneous passage of stones within 6-weeks of MET. Another 38.9% passed the stone within the next 6-weeks. Thirty-eight patients (17.8%) required surgery. Uncomplicated ureteric stones up to 10 mm can be given a trial of MET using tamsulosin which can be extended up to 12-weeks with a success rate over 92%. This may have substantial clinical and fiscal benefits by reducing the number of interventional procedures especially in resource-poor settings.

Objective To compare the efficacy of tamsulosin, silodosin, and silodosin plus tadalafil as medical expulsive therapy (MET) for distal ureteric calculi. Methods In all, 120 patients who met the inclusion criteria were randomised into one of three treatment arms: tamsulosin (Group A), silodosin (Group B), and silodosin plus tadalafil (Group C). 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, number of pain episodes, and side-effects associated with MET. The follow-up period was for 4 weeks, after which ureteroscopic lithotripsy was done to remove any stones that were not expelled. Results There was a statistically significantly higher stone expulsion rate in Group C (90%) as compared to groups A (57.5%) and B (77.5%) with a shorter mean time to stone expulsion. Also, there were statistically fewer pain episodes in Group C as compared to groups A and B. There were no serious side-effects. Conclusion The present study concludes that the combination of silodosin and tadalafil increases the ureteric stone expulsion rate and decreases the expulsion time significantly. This combination provided significantly better control of pain without any serious side-effects. [ABSTRACT FROM AUTHOR]

Urolithiasis is one of the most common conditions seen in urology practice. Renal transplantation is associated with a lower incidence of urolithiasis compared to general population. In these patients, the incidence of isolated ureteric calculi is 5–10 times lower than renal calculi. If renal and/or ureteric calculi are present in transplanted kidney, they must be attended urgently as the presentation in such patients is atypical due to lack of sympathetic innervation of the graft kidney and the condition may rapidly progress to graft dysfunction. The diagnosis of renal and upper ureteric calculi is usually made on graft ultrasonography. For mid and distal ureteric calculi, CT and MR urography are more sensitive. For nonobstructive calculi, treatment is with extracorporeal shock wave lithotripsy (ESWL) or flexible ureteroscopic removal for smaller stone burden (

Congenital megaureter is an important differential diagnosis among the known causes of hydroureteronephrosis in children. Obstructive megaureter is usually due to a narrowed and aperistaltic prevesical portion of the ureter. The congenital megaureter is usually asymptomatic in children. Association of an obstructive megaureter with ureteric calculi, however, is a rare phenomenon in the pediatric age group. Calculi if present are usually secondary to stasis and asymptomatic, presenting usually at adulthood or adolescence. A differential diagnosis of obstructive megaureter should be kept in mind in a child who presents with symptoms such as hematuria, pain, and obstructive nephropathy, especially when there are an associated calculi in the ureter. We present a case of a 4-year-old child whose chief complaint was hematuria and on further investigation was found to have unilateral obstructive megaureter with secondary ureteric calculi on an intravenous urogram.

Objective: Although medical expulsive therapy (MET) is shown to be effective for ureteric calculi, the optimum duration and the stone size suitable for MET are not well established yet. The objectives of the study were to determine the optimum duration and maximum stone size suitable for MET. Results: All patients with radiologically confirmed uncomplicated ureteric calculi treated with MET using tamsulosin over a period of 6 months in the outpatient setting were followed up. There were 213 patients. 165 were men. Mean age was 42 years. At presentation 42 stones were in upper ureter (19.7%), 51 in mid ureter (23.9%), 120 in lower ureter (56.3%). The majority (82.7%) of stones were less than 10 mm. Seven stones (3.3%) were over 15 mm. Ninety-two (43.2%) patients had spontaneous passage of stones within 6-weeks of MET. Another 38.9% passed the stone within the next 6-weeks. Thirty-eight patients (17.8%) required surgery. Uncomplicated ureteric stones up to 10 mm can be given a trial of MET using tamsulosin which can be extended up to 12-weeks with a success rate over 92%. This may have substantial clinical and fiscal benefits by reducing the number of interventional procedures especially in resource-poor settings. [ABSTRACT FROM AUTHOR]

Background: Stone retropulsion represents a challenge for intracorporeal lithotripsy of ureteral calculi. The consequences are an increased duration and cost of surgery as well as decreased stone-free rates. The use of additional tools to prevent proximal stone migration entails further costs and risks for ureteral injuries. We present the simple technique of using a coil of the routinely used guidewire to prevent stone retropulsion.Methods: We retrospectively evaluated all patients with mid-to-proximal ureteral stones in 2014, which were treated by ureteroscopic lithotripsy (Ho: YAG and/or pneumatic lithotripsy). The preoperative stone burden was routinely assessed using low dose CT scan (if available) and/or intravenous pyelogram.Results: The study population consisted of 55 patients with 61 mid-to-proximal calculi. Twentyseven patients underwent semirigid ureterorenoscopy using the "Guidewire-Coil-Technique", the second group (n = 28) served as control group using the guidewire as usual. There has been a statistically significant reduction of accidental stone retropulsion (2/27 vs. 8/28, p < 0.05) as well as a decreased use of auxiliary procedures (p < 0.05) compared to the control group. No difference was observed in operative time. One ureteral injury in the control group required a prolonged ureteral stenting.Conclusion: The "Guidewire-Coil-Technique" is a simple and safe procedure that may help to prevent proximal calculus migration and therefore may increase stone-free rates without causing additional costs. [ABSTRACT FROM AUTHOR]

Background: Urolithiasis, usually affecting people in the prime of life, causes significant morbidity and loss of productivity. Uretericstones account for 2/3rd of all urinary calculi brought to attention of doctors. The damaging effects of the calculi may result in obstruction with dilatation of the urinary tract, leading to stasis and severe infection. Aims and Objectives: To evaluate patients with urinary stones with regards to the incidence, age, sex,clinical presentation, site, size, side, management and their complications. Material and Methods:It was a prospective study carried out by Department of Surgery at Annasaheb Chudaman Patil Memorial Medical College, and Hospital Dhule for a period of two years. Patients were selected after they were diagnosed as having ureteric calculi. The patients were treated by conservative or surgical methods, and the outcome was monitored. Statistical analysis of the data was done for obtaining results.Result: The majority of the patients were males with peak age group in the second and third decade. Pain in abdomen or loin tenderness was the most common presenting symptom. Most of the patients were treated by conservative medical management. Endourological procedures were the most commonly performed surgical intervention. Conclusion: Most of the patients with ureteric calculi present with painin abdomen and majority can be treated by medical management. With the availability of better facilities the requirement for open surgery is decreasing and endourological procedures are becoming the means of surgical intervention.Complications are minimal with surgical expertise for endourological procedures.

Clinical questionIs ultrasonography a safe and practical alternative to computed tomography for the initial investigation of suspected nephrolithiasis?Article chosenSmith-Bindman R, Aubin C, Bailitz J, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med 2014;371(12):1100-10.ObjectiveTo assess the safety and efficacy of ultrasonography as a first-line imaging investigation for patients with suspected nephrolithiasis. [ABSTRACT FROM PUBLISHER]

Aims & Objectives: Placement of a ureteral stent is routinely done followed by ureteroscopy. Recently, many researchers have questioned routine stenting after ureteroscopy for management of distal ureteric stones? We report our outcomes of a randomized study comparing ureteroscopy with and without placement of stents for management of distal ureteric stones. Study Design: Randomized controlled trial. Setting: Department of Urology, Jinnah Hospital/ Allama Iqbal Medical College, Lahore. Period: March 2013 to February, 2015. Materials & methods: Total 155 patients were prospectively divided into three groups to receive a double J stent (Group I, 54 patients), ureteral stent (Group II, 50 patients) and no stent (Group III, 51 patients), underwent ureteroscopic treatment of distal ureteric stones. Characteristics of stones, operation time, postoperative pain, lower urinary tract symptoms, and analgesia need for postoperative pain, hospitalization, stone free rate and late postoperative complications were all studied. Results: There were no significant differences in preoperative data. There was no statistical significant difference between three groups regarding hematuria, fever, flank pain, urinary tract infection and re-hospitalization. At 48 hours and 1 week, frequency/ urgency and dysuria were significantly less group III. When comparing Group I and Group III, patients with double J stent has statistically significant more bladder pain 0, frequency/ urgency 0, dyusuria 0 and need of analgesia 0. All patients of the three groups assessed postoperatively by imaging did not suffer any obstruction or ureteral stricture. Conclusion: Uncomplicated ureteroscopy without stent placement for treatment of distal ureteral stones is a safe procedure. Patients without stents have significantly fewer irritative bladder symptoms and are not at risk of complications. [ABSTRACT FROM AUTHOR]

Objectives To assess the probability of spontaneous stone passage and its predictors after drainage of obstructed kidney by JJ stent, as insertion of an internal ureteric stent is often used for renal drainage in cases of calcular ureteric obstruction. Patients and methods Between January 2011 and June 2013, patients for whom emergent drainage by ureteric stents were identified. The patients’ demographics, presentation, and stone characteristics were reviewed. The primary endpoint for this study was stone-free status at the time of stent removal, where all patients underwent non-contrast spiral computed tomography (NCCT) before stent removal. Ureteroscopic stone extraction was performed for CT detectable ureteric stones at the time of stent removal. Potential factors affecting the need for ureteroscopic stone extraction at the time of stent removal were assessed using univariate and multivariate statistical analyses. Results Emergent ureteric stents were undertaken in 196 patients (112 males, 84 females) with a mean (SD) age of 53.7 (16.2) years, for renal obstruction drainage. At the time of stent removal, 83 patients (42.3%) were stone free; with the remaining 113 patients (57.7%) undergoing ureteroscopic stone extraction. On multivariate analysis, stone width [odds ratio (OR) 15.849, 95% confidence interval (CI) 2.83; P = 0.002) and radio-opaque stones (OR 12.035, 95% CI 4.65; P < 0.001) were independent predictors of the need for ureteroscopic stone extraction at the time of stent removal. Conclusion Spontaneous ureteric stone passage is possible after emergent drainage of an obstructed kidney by ureteric stenting. Stone opacity, larger stone width, and positive preoperative urine culture are associated with a greater probability of requiring ureteroscopic stone extraction after emergent drainage by ureteric stenting. [ABSTRACT FROM AUTHOR]

Several professional organizations have developed evidence-based guidelines for the initial evaluation, diagnostic imaging selection, symptomatic management, surgical treatment, medical therapy, and prevention of recurrence for both ureteric and renal stones. The purpose of this article is to summarize these guidelines with reference to the strength of evidence. All guidelines endorse an initial evaluation to exclude concomitant infection, imaging with a non-contrast computed tomography scan, and consideration of medical expulsive therapy or surgical intervention depending on stone size and location. Recommends for metabolic evaluation vary by guideline, but all endorse increasing fluid intake to reduce the risk of recurrence. [ABSTRACT FROM AUTHOR]

A good understanding of the anatomy of the kidney and ureter is imperative while dealing with patients with abdominal trauma and those undergoing abdominopelvic surgery. The kidneys are situated in the retroperitoneum and are enveloped by the renal fascia. The renal fascia prevents the extravasation of blood during renal trauma. The lower poles of the kidneys are more prone to trauma as they are inferior to the 12th rib. However, due to the proximity of the kidneys to the lower ribs and pleura there is a risk of pleural injury during percutaneous renal interventions. Relative paucity of blood vessels in the postero-lateral convex border of the kidney (Brodel's bloodless line) provides a relatively safe access to the pelvicalyceal system. The ureter has an abdominal and pelvic course and has three physiological narrowings: the uretero-pelvic junction, the point where the ureters cross the common iliac artery and the intra-vesical part of the ureter. These are the commonest sites for impacted calculi. The intra-vesical portion of the ureter is the narrowest portion of the ureter and this oblique intramural course helps in the formation of a functional sphincter that prevents vesico-ureteric reflux. The ureter is at risk of injury during colonic, vascular and gynaecological surgery. [ABSTRACT FROM AUTHOR]

Objective To evaluate the outcome of the expectant management of ureteric stones and to determine the factors predictive of the spontaneous passage of stones. Patients and methods We retrospectively reviewed the medical records of patients who had ureteric stones of ⩽10 mm and who were treated conservatively at our institutions during the period 2008–2013. The stone-passage rate and time, and different clinical, laboratory and radiological variables, were analysed. Results In all, 163 patients with ureteric stones were enrolled in the study, of whom 127 (77.9%) passed their stones spontaneously, with a mean (SD) passage time of 24.0 (8.09) days. The cumulative stone-passage rate was 1.6%, 15%, 41.7%, 72.4%, 89.8% and 98.4% at 7, 14, 21, 28, 35 and 42 days from the first presentation, respectively. Patients with a high pain-scale score, stones of ⩽5 mm, a lower ureteric stone, a high white blood cell count and those with absent computed tomography (CT) findings of perinephric fat stranding (PFS) and tissue-rim sign (TRS) had a higher likelihood of spontaneous stone passage. Patients with stones of ⩽5 mm, stones in the lower ureter and those with no PFS had a shorter spontaneous passage time. In a multivariate analysis the absence of PFS and TRS were the only significant predictors for spontaneous stone passage ( P < 0.001 and 0.002, respectively). Conclusions The spontaneous ureteric stone-passage rate and time varies with different factors. The absence of CT findings of PFS and TRS are significant predictors for stone passage, and should be considered when choosing the expectant management. [ABSTRACT FROM AUTHOR]

Objective To evaluate the outcome of using semi-rigid ureteroscopy with or without intracorporeal pneumatic lithotripsy vs. temporary ureteric JJ stenting in the management of obstructing ureteric calculi in pregnant women. Patients and methods This prospective comparative study comprised 43 pregnant women with obstructing ureteric calculi. The diagnosis was based on the acute flank pain as the main symptom, microscopic haematuria, and unilateral hydronephrosis on abdominal ultrasonography (US). The patients were randomly divided into two groups; those in group 1 (22 patients) were treated by temporary ureteric JJ stenting until after delivery, and those in group 2 (21) were treated definitively by ureteroscopic stone extraction with intracorporeal pneumatic lithotripsy. Postoperative complications and the degree of patient satisfaction were reported. Results An obstructing ureteric stone was identified by US in 68% and 76% of groups 1 and 2, respectively. In group 1, nine patients had mid-ureteric stones and 13 had stones in the lower ureter. In group 2, seven patients had mid-ureteric stones, whilst the stones were in the distal ureter in 14. No perioperative foetal complications were detected in any group and all patients completed the full term of pregnancy. In group 1, four patients had a postoperative urinary tract infection (UTI), and the JJ stent was exchanged in seven. Two patients in group 2 had a postoperative UTI. Conclusions Definitive ureteroscopy, even with intracorporeal pneumatic lithotripsy, is an effective and safe treatment for pregnant women with obstructing ureteric calculi. It has a better outcome and is more satisfactory for the patients than a temporary JJ stent. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the sensitivity and specificity of noncontrast helical computerized tomography (CT) in ureteric colic with comparative evaluation of KUB and ultrasonography (USG). Setting: Tertiary care university hospital. Materials and Methods: One hundred patients aged between 20 and 75 years referred from the emergency department as acute ureteric colic were evaluated with KUB and USG followed by noncontrast helical CT. Results: Noncontrast helical CT was 91% sensitive and 98% specific in detecting urolithiasis compared to a sensitivity of 20% and 30% for KUB and USG and specificity of 94% and 98% respectively. Conclusion: Noncontrast helical CT is a very sensitive and specific investigation for evaluation of acute flank pain due to urolithiasis, besides helping in the detection of nonrenal causes of pain.

Objective To assess trends in the surgical management of ureteric calculi over a 10-year period., Materials and Methods An analysis of the 5% Medicare Public Use Files, from 2001, 2004, 2007 and 2010, was performed to assess the use of ureteroscopy ( URS), extracorporal shockwave lithotripsy ( ESWL) and ureterolithotomy ( UL) in treating ureteric calculi., Patients were identified using International Classification of Diseases 9th edition (Clinical Modification) and Current Procedure Terminology codes., Statistical analyses using the Fisher and chi-squared tests, and multivariate logistic regression analysis (dependent variables: URS, ESWL, UL, treatment, no treatment; independent variables: age, gender, ethnicity, geography and year of treatment) were performed., Results A total of 299 920 patients with ureteric calculi were identified. Of these, 115 200 underwent surgery., Men (odds ratio [ OR] = 1.15, P < 0.001) were more likely, while patients from ethnic minorities ( OR = 0.84, P = 0.004) were less likely to be treated. Patients in the West of the USA were also less likely to be treated ( OR = 0.76, P < 0.001) as were patients aged <65 or >84 years old ( P = 0.29)., The predominant surgical approach was URS (65.2%), followed by ESWL (33.6%) and UL (1.2%)., The use of URS increased over time, while the use of ESWL and UL declined., Women ( OR = 1.25, P < 0.001) were more likely to undergo URS. Patients in the South of the USA ( OR = 1.51, P < 0.001) and patients from ethnic minorities were more likely to undergo ESWL ( OR = 1.23, P = 0.03)., Conclusions The surgical treatment of ureteric calculi changed significantly between 2001 and 2010., The use of URS expanded at the expense of ESWL and UL., Multiple inequalities existed in overall surgical treatment rates and in the choice of treatment; age, gender, ethnicity and geography influenced both whether patients underwent surgical intervention and the type of surgical approach used. [ABSTRACT FROM AUTHOR]

Objective: To compare patient-reported outcomes (PROs) with objective outcomes after shock wave lithotripsy (SWL) and ureteroscopic surgery (URS) for ureteral calculi (UC). Methods: We prospectively evaluated 160 consecutive patients who underwent SWL ( n = 65) or URS ( n = 95) for a single radiopaque UC ranging from 4 to 15 mm. For patients who underwent URS, a 6-Fr double-J stent was routinely placed for 2 weeks after surgery. To examine PRO, we used a self-administered nonvalidated questionnaire evaluating overall satisfaction and PRO in four domains (pain, hematuria, voiding symptom, and time to return to routine activity) and willingness to undergo the treatment procedure again. Propensity-score matching analysis was performed to adjust for potential confounding by discrepancy of pretreatment parameters between groups. Stone-free rates (SFRs) and complications were also compared. Results: SFRs after the first, second, and third sessions of SWL were 61.5, 81.0, and 93.5 %, respectively. SFR after URS was 100 %, which was significantly better than SFRs for third-session SWL ( p = 0.023). Complications were comparable. By propensity-score matching analysis, overall satisfaction was similar between groups, whereas PRO for voiding symptom and time to return to routine activity were significantly better in the SWL group (all p < 0.05). The two groups were not different in willingness to undergo the same procedure again. Conclusions: Despite significantly higher SFR after URS for UC, overall patient satisfaction was comparable after SWL and URS, meanwhile PRO of the SWL group was better than URS for voiding symptom and time to return to routine activity. In addition of objective treatment outcomes, PROs should be considered in counseling treatment methods for UC. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To assess and compare, in a randomised clinical trial, the efficacy of tamsulosin and nifedipine as medical expulsive therapy for distal ureterolithiasis. Patients and methods: In all, 128 symptomatic patients with stones in the juxtavesical tract of the ureter were randomly divided into group 1 (64 patients) receiving oral nifedipine sustained-release 30mg/day, and group 2 (64 patients) receiving tamsulosin 0.4mg/day. Both groups received oral prednisolone 30mg/day for 10days and diclofenac 75mg intramuscularly on demand. Patients were assessed by weekly ultrasonography with or with no abdominal computed tomography, during a follow-up of 4weeks. The stone passage rate and time, analgesic use, hospitalisation and endoscopic interventions were evaluated. The results were analysed statistically using appropriate tests. Results: The stone expulsion rate was 55% for group 1 and 80% for group 2 (P =0.004). The mean stone size was 8.59 and 8.85mm in groups 1 and 2, respectively. The mean expulsion time was 23days for group 1 and 9days for group 2 (P <0.001). The mean number of diclofenac injections was 1.19 for group 1 and 0.42 for group 2 (P <0.001). Eleven patients in group 1 vs. two in group 2 were hospitalised (P =0.001). Twenty-six patients in group 1 and 13 in group 2 underwent ureteroscopy (P <0.001). Conclusions: Medical expulsive therapy with tamsulosin should be considered as a first-line treatment for index cases of distal ureterolithiasis with no complications. The use of tamsulosin provides better stone expulsion than does nifedipine. [Copyright &y& Elsevier]

Few studies show that 'emergency extracorporeal shockwave lithotripsy (eESWL)' reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient's age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, ( p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower ureter in group 1 compared to 11, 5, and 10 in group 2, respectively. Mean HU in group 1 was 480 and 612 in group 2 ( p value 0.0036). In group 2, significantly, more patients received treatment after 24 h compared with group 1 (38 vs 22.5 %). The number of shock waves, maximal intensity, and ESWL sessions were not significantly different in the two groups. No complications were noted. eESWL is safe and effective in patients with ureteric colic. Stone size and Hounsfield units are important factors in predicting success. Early treatment (≤24 h) minimizes stone impaction and increases the success rate of ESWL. [ABSTRACT FROM AUTHOR]

Objective To determine trends in demographics and treatment for inpatient upper urinary tract calculi in the USA using a population-based cohort., Patients and Methods All patients with a primary or secondary diagnosis of kidney or ureteric calculus between 1999 and 2009 in the US Nationwide Inpatient Sample were extracted and weighted., Temporal trend analyses were used to determine trends in gender, race and age presentation, as well as utilization rates of interventions., Temporal trends were quantified using the estimated annual percent change ( EAPC) using least squares linear regression analysis., Results Overall, 2 109 455 patients were hospitalized with upper urinary tract calculi over the 11-year period. The majority of admissions were for ureteric calculi (63.4%)., Admissions for renal calculus increased by 12.1% during the study period ( EAPC + 0.92%, P = 0.039, 95% CI: 0.17-1.66), whilst discharges for ureteric calculus remained stable., A significant increase (25.4%) in hospitalizations for women was found ( EAPC + 2.21%, P < 0.001, 95% CI: 1.40-3.03); by 2006, more women than men were admitted to hospital (95 953 vs. 94 556, respectively)., There were significant increases in hospitalization for black, Hispanic and older patients., Significant changes in the use of all studied interventions were found except for ureteroscopy, extracorporeal shockwave lithotripsy and nephrectomy., Conclusions In this nationally representative sample of inpatient discharges, significant increases were found in admissions for renal compared with ureteric calculi, and for black, Hispanic and older patients., With regard to surgical intervention, the largest increase was found in the use of procedures for kidney calculi., Women now comprise the majority in the inpatient management of stone disease. [ABSTRACT FROM AUTHOR]

Background: Urolithiasis, usually affecting people in the prime of life, causes significant morbidity and loss of productivity. Ureteric tones account for 2/3rd of all urinary calculi brought to attention of doctors. The damaging effects of the calculi may result in obstrucion with dilatation of the urinary tract, leading to stasis and severe infection. Aims and Objectives: To evaluate patients with urinary tones with regards to the incidence, age, sex, clinical presentation, site, size, side, management and their complications. Material and Methods: It was a prospective study carried out by Department of Surgery at Annasaheb Chudaman Patil Memorial Medical College, and Hospital Dhule for a period of two years. Patients were selected after they were diagnosed as having ureteric calculi. The patients were related by conservative or surgical methods, and he outcome was monitored. Statistical analysis of the data was done for obtaining results. Result: The majority of the patients were males with peak age group in the second and third decade. Pain in abdomen or loin tenderness was he most common presenting symptom. Most of the patients were treated by conservative medical management. Endourological procedures were the most commonly performed surgical intervention. Conclusion: Most of the patients with ureteric calculi present with pain in abdomen and majority can be treated by medical management. With the availability of better facilities the requirement for open surgery is decreasing and endourological procedures are becoming the means of surgical intervention. Complications are minimal with surgical expertise for endourological procedures. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To present our clinical outcomes in the management of anuria in adult patients caused by ureteral calculi by using of ureteroscopy and holmium laser. Materials and methods: Nineteen patients presented with calcular anuria with ages between 19 and 48years. The presentation was anuria with serum creatinine levels of 2–5.5mg% (mean 3.5) and hyperkalemia in nine patients (5.2–6.1mmol/L). There were bilateral ureteric stones in 14 (73.7%) and unilateral in five (26.3%) with single functioning kidney. Thirty-three ureteroscopic procedures were performed for 19 patients including bilateral ureteroscopy in 14. Laser lithotripsy was delivered using holmium laser via 356μm laser fibre, with energy (1–1.2J) and pulse rate (10Hz). Post-operatively, monitoring of urine output, serum creatinine and K levels was done until normal values were obtained. Results: Ureteroscopy was performed for all 19 patients (33 procedures), but laser lithotripsy was done successfully in 30 procedures. The operative time was 46min (25–70). The successful fragmentation rate was (100%). The stone-free rate was 90.9%. There were mucosal abrasions in 6 (31.5%), and mild to moderate haematuria in 9 (47.4%), and high fever in two patients (10.5%). Serum creatinine and potassium levels returned to normal within 7–10days. Urine output gradually reached normal level within a week. Conclusions: Ureteroscopy and holmium laser lithotripsy represent an effective and safe modality for the treatment of anuria caused by ureteral calculi. [Copyright &y& Elsevier]

The present study was designed to evaluate the clinical outcome of using extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi and to establish a predictive model for the stone-free rate in patients receiving the treatment. A total of 831 patients with ureteric calculi were accepted in this study. Several parameters, including stone site, stone number, stone size, history of urolithiasis, renal colic, hydronephrosis, and double-J ureteric stent, were analyzed using univariate and multivariate analyses. A prediction model was established based on the logistic regression analysis of the significant factors, and the goodness-of-fit of the model was evaluated by employing the Hosmer-Lemeshow test. At a 3-month follow-up after ESWL treatment, the overall stone-free rate was 96.8% (804/831) with no serious complications being found, while the treatment failed in 3.2% (27/831) of the patients. Five factors, including stone number, stone size, history of urolithiasis, renal colic, and double-J ureteric stent contributed significantly to the clinical outcome of the ESWL treatment. The prediction model had a sensitivity and overall accuracy of 99.8 and 96.9%, respectively. The results show that ESWL remains an effective method for treating ureteric calculi. The prediction model established in this study could be used as a method for estimating prognosis in patients following ESWL treatment. [ABSTRACT FROM AUTHOR]

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To investigate the effect of renal function on the stone-free rate (SFR) of proximal ureteric stones (PUS) after extracorporeal shock wave lithotripsy (ESWL), as urinary obstruction caused by PUS can impair renal function, and elevated serum creatinine levels are associated with decreased ureteric stone passage. PATIENTS AND METHODS From January 2005 to December 2007, 1534 patients had ESWL for urolithiasis, 319 having ESWL in situ for PUS; they were reviewed retrospectively. Patients requiring simultaneous treatment of kidney stones, placement of a double pigtail stent, or percutaneous pigtail nephrostomy tube were excluded. We divided patients into groups by chronic kidney disease (CKD) stage according to the estimated glomerular filtration rate (eGFR) of ≥60 and <60 mL/min/1.73 m2. Stone-free status was defined as no visible stone fragments on a plain abdominal film at 3 months after ESWL. A logistic regression model was used to evaluate the possible significant factors that influenced the SFR of PUS after ESWL, and to develop a prediction model. RESULTS The overall SFR of PUS (276/319 patients) was 86.5%; the SFR was 93% in patients with an eGFR of ≥60 and 50% in those with an eGFR of <60 ( P < 0.001). After univariate and multivariate analysis, the three significant factors affecting SFR were an eGFR of ≥60, stone width, and gender, with odds ratios (95% confidence intervals) of 19.54 (8.25–46.30) ( P < 0.001), 0.67 (0.55–0.82) ( P < 0.001) and 0.16 (0.05–0.50 ( P = 0.002), respectively. A logistic regression model was developed to estimate the probability of SFR after ESWL, the equation being 1/(1 + exp [−(3.8137 − 0.3967 × (stone width) + 2.9724 × eGFR − 1.8120 × Male)]), where stone width is the observed value (mm), eGFR = 1 for eGFR ≥60 and 0 for <60, and male = 1 for male, 0 for female. CONCLUSIONS Gender, eGFR ≥60 and a stone width of >7 mm were significant predictors affecting the SFR after one session of ESWL for PUS. [ABSTRACT FROM AUTHOR]

Urolithiasis is one of the most common conditions seen in urology practice. Renal transplantation is associated with a lower incidence of urolithiasis compared to general population. In these patients, the incidence of isolated ureteric calculi is 5–10 times lower than renal calculi. If renal and/or ureteric calculi are present in transplanted kidney, they must be attended urgently as the presentation in such patients is atypical due to lack of sympathetic innervation of the graft kidney and the condition may rapidly progress to graft dysfunction. The diagnosis of renal and upper ureteric calculi is usually made on graft ultrasonography. For mid and distal ureteric calculi, CT and MR urography are more sensitive. For nonobstructive calculi, treatment is with extracorporeal shock wave lithotripsy (ESWL) or flexible ureteroscopic removal for smaller stone burden (<1.5 cm) while obstructive calculi and larger stones are best addressed with percutaneous nephrostomy followed by percutaneous nephrolithotomy (PCNL) or ESWL or endoscopic removal. [ABSTRACT FROM AUTHOR]

Aim: In this retrospective study, we aimed to compare the treatment results of pneumatic and holmium laser-assisted ureteroscopy in managing distal ureteral calculi in children. Materials and methods: The study group included a total of 36 children (23 boys, 13 girls) who underwent ureteroscopy between June 1998 and April 2008 due to distal ureteral calculi. Pneumatic lithotripsy was performed in 11 children and holmium:YAG laser lithotripsy in 25. Results: Their ages ranged from 18 months to 14 years (mean: 8.5 ± 3.5 years). The overall success rate for the holmium:YAG laser lithotripsy (100%) was higher than that of pneumatic lithotripsy (81.8%), but the difference was insignificant (P = 0.087). The complication rate was higher in pneumatic lithotripsy than in holmium:YAG laser lithotripsy (36.4% versus 4%, P = 0.023). Treatment time and hospital stay were shorter in the holmium:YAG laser lithotripsy group than in the pneumatic lithotripsy group (32.4 min versus 42.3 min, P = 0.041; 17.4 h versus 33.6 h, P = 0.013, respectively). Conclusion: This study showed that the success rate for holmium:YAG laser lithotripsy was almost identical with that achieved by pneumatic lithotripsy in the treatment of distal ureteral stones; ureteroscopic holmium:YAG laser lithotripsy had significant clinical advantages over pneumatic lithotripsy in terms of operative time, and hospitalization duration, stent requirements, and complication rates. [ABSTRACT FROM AUTHOR]