Likelihood of Distal Ureteric Calculi to Pass Spontaneously: Systematic Review and Cumulative Analysis of the Placebo Arm of Randomized-Controlled Trials

The role of the general practictioner in the management of urinary calculi

BACKGROUND

The prevalence of kidney stones tends to increase worldwide due to dietary and climate changes. Disease management involves a high consumption of healthcare system resources which can be reduced with primary prevention measures and prophylaxis of recurrences. In this field, collaboration between general practitioners (GPs) and hospitals is crucial.

METHODS

a panel composed of general practitioners and academic and hospital clinicians expert in the treatment of urinary stones met with the aim of identifying the activities that require the participation of the GP in the management process of the kidney stone patient.

RESULTS

Collaboration between GP and hospital was found crucial in the treatment of renal colic and its infectious complications, expulsive treatment of ureteral stones, chemolysis of uric acid stones, long-term follow-up after active treatment of urinary stones, prevention of recurrence and primary prevention in the general population.

CONCLUSIONS

The role of the GP is crucial in the management and prevention of urinary stones. Community hospitals which are normally led by GPs in liaison with consultants and other health professional can have a role in assisting multidisciplinary working as extended primary care.

A machine learning model for predicting surgical intervention in renal colic due to ureteral stone(s) < 5 mm

A 75-89% expulsion rate is reported for ureteric stones ≤ 5 mm. We explored which parameters predict justified surgical intervention in cases of pain caused by < 5 mm ureteral stones. We retrospectively reviewed all patients with renal colic caused by ureteral stone < 5 mm admitted to our urology department between 2016 and 2021. Data on age, sex, body mass index, the presence of associated hydronephrosis/stranding on images, ureteral side, stone location, medical history, serum blood count, creatinine, C-reactive protein, and vital signs were obtained upon admission. XGboost (XG), a machine learning model has been implemented to predict the need for intervention. A total of 471 patients (median age 49, 83% males) were reviewed. 74% of the stones were located in the distal ureter. 160 (34%) patients who sustained persistent pain underwent surgical intervention. The operated patients had proximal stone location (56% vs. 10%, p < 0.001) larger stones (4 mm vs. 3 mm, p < 0.001), longer length of stay (3.5 vs. 3 days, p < 0.001) and more emergency-room (ER) visits prior to index admission (2 vs. 1, p = 0.007) compared to those who had no surgical intervention. The model accuracy was 0.8. Larger stone size and proximal location were the most important features in predicting the need for intervention. Altogether with pulse and ER visits, they contributed 73% of the final prediction for each patient. Although a high expulsion rate is expected for ureteral stones < 5 mm, some may be painful and drawn out in spontaneous passage. Decision-making for surgical intervention can be facilitated by the use of the present prediction model.

Patients’ life quality during ureterorenoscopy, ureterorenoscopy plus JJ insertion and shock wave lithotripsy in the management of distal ureteral stone: a prospective clinical study

Background

To clarify the effects of ureterorenoscopy (URS) and shock wave lithotripsy (SWL) on patients’ life quality in the management of distal ureteral stone (DUS) with using Short Form 36 (SF 36).

Methods

The present study was conducted in a prospective manner between July 2018 and July 2021. Patients who had DUS stone smaller than 1.5 cm were accepted as candidates for the study. Preoperative patient characteristics and treatment outcomes were recorded. Also, the SF-36 form was completed one day before the procedure and one month after the procedure. Patients were divided into three groups according to treatment modality as SWL, only URS, and URS including JJ stent insertion.

Results

Totally, 44 patients were treated with SWL, 27 patients were treated with URS, and 31 patients were treated with URS including JJ insertion. Hospitalisation period was significantly shorter in the SWL group (p = 0.001). Additionally, patients treated with SWL had a significantly lower analgesia requirement rate (31.8% in SWL group, 77.8% in URS group and 64.5% in URS + JJ stent group, p = 0.001). Stone-free status and complications did not significantly differ between groups (p = 0.846 and p = 0.096). Physical functioning score and role physical domains were significantly increased in patients treated with SWL (p = 0.005 and p = 0.031). Similarly, highest improvement for the body pain domain was achieved in the SWL group (p = 0.006).

Conclusion

The present study showed that URS, URS with JJ insertion and SWL are safe and reliable procedures for the management of DUS. However, hospitalisation time was significantly shorter and analgesia requirements were significantly lower in favour of SWL. Additionally, SWL was related with better SF-36 domains including physical functioning, role physical and body pain.

Update on the Management of Urological Problems Following Kidney Transplantation

Urological problems in kidney transplant recipients are not limited only to posttransplantation urological complications. These problems are a cause of significant patient mortality and morbidity that have wide-ranging effects on graft survival throughout the entire life of the graft. Ultimately, the transplant comprises a major portion of the urinary system; therefore, the transplant team should be prepared for foreseeable and unforeseeable urological problems in the short and long terms. These mainly include postoperative urological complications (urine leakage, ureteral stenosis, and vesicoureteral reflux), bladder outlet obstruction, and graft urolithiasis. In recent years, significant advances have been made in the management of urological complications, especially due to advances in endourologic interventions. The aim of this review is to summarize the management of urological problems after kidney transplantation in the context of the current literature.