Percutaneous nephrostomy versus ureteral stent in hydronephrosis secondary to obstructive urolithiasis: A systematic review and meta-analysis

Objective

To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requiring urgent drainage, by evaluating outcomes regarding urinary symptoms, quality of life (QoL), spontaneous stone passage, and length of hospital stays, since there is no literature stating the superiority of one modality over the other.

Methods

We searched MEDLINE and other sources for relevant articles in June 2019 without any date restrictions or filters applied. The selection was done first by the title and abstract screening and then by full-text assessment for eligibility. Only randomized controlled trials or cohort studies in patients with hydronephrosis secondary to obstructive urolithiasis that presented comparative data between PCN and RUS placement concerning at least one of the defined outcome measures were included. Lastly, MEDLINE database and PubMed platform were screened again using the same terms, from June 2019 until November 2022.

Results

Of 556 initial articles, seven were included in this review. Most works were considered of moderate-to-high quality. Three studies regarding QoL showed a tendency against stenting, even though only one demonstrated statistically significant negative impact on overall health state. Two works reported significantly more post-intervention urinary symptoms in stenting patients. One article found that PCN is a significant predictor of spontaneous stone passage, when adjusted for stone size and location. Findings on length of hospital stays were not consistent among articles.

Conclusion

PCN appears to be the intervention better tolerated, with less impact on the patient's perceived QoL and less post-operative urinary symptoms, in comparison with RUS. Nevertheless, further studies with larger samples and a randomized controlled design are suggested.

Management of Urologic Conditions in Small Ruminants

Small ruminants frequently experience urologic conditions, such as obstructive urolithiasis, posthitis, vulvitis, and urinary tract infections. Urologic conditions are more common in male small ruminants, especially castrated males, primarily due to their anatomy. Traditionally, urologic conditions warranted culling from the herd without significant efforts in treatment. However, more goats and sheep are now being kept as pets. Small ruminant owners have strong emotional attachments to their animals and are more likely to seek treatment of medical disorders, including urologic conditions. Surgical or medical treatments are available. Conditions also may be avoided through hydration, diet, hygiene, and other means.

Ultrasonography and Surgical Treatment of an Unusual Case of Urethral Calculus in an Arabian Horse

This case report records an obstructive urolithiasis due to a large calcium carbonate urethral stone in an 11-year-old Arabian stallion. The stallion had colicky pain, anuria, and reduction in food and water intakes. Palpation of the penis revealed rhythmic contractions of the urethra, a hard mass in the penile urethra at the level of the ischial arch, and a dilated urethra proximal to the mass. Rectal examination revealed a distended and turgid urinary bladder. Passing a urethral catheter revealed a complete urethral obstruction at the level of the ischial arch. Ultrasonography revealed a calculus that appeared as an irregular, hyperechoic arch-like thick line with acoustic shadowing. Subischial urethrotomy was conducted under epidural anesthesia. Uneventful recovery was seen with no recurrence or complications for 12 months of available follow-up. In conclusion, clinical, rectal, and ultrasound examinations are valuable for definite diagnosis of urethral calculi in horses and the subischial urethrotomy appears to be successful in correcting this condition in horses.

Urokinase alteration and its correlation with disease severity and oxidative/nitrosative stress in buffalo calves with obstructive urolithiasis

The present study was aimed to understand the development of bovine urolithiasis through measuring oxidative/nitrosative, cortisol and urokinase status and their relationship with disease severity. The cases of buffalo calves with obstructive urolithiasis were selected based on clinical signs, ultrasonography and laboratory examination of blood and urine (creatinine, urea nitrogen). Total 35 urolithiatic buffalo calves (urolithiatic controls) and 6 healthy calves (healthy controls) were used for study. Further, calves of urolithiatic control were sub-divided into two groups based on disease severity: mild (n = 10) and severe (n = 25) form. Oxidative/nitrosative stress were evaluated based on serum malondialdehyde (MDA), glutathione-S-transferase (GST), nitric oxide (NO) parameters. Serum cortisol was evaluated to measure stress hormone status. Serum and urine urokinase were measured and its relationship with disease severity and oxidative/nitrosative stress were established. Obstructive urolithiasis resulted in significant (p < .05) increase in biochemical parameters (creatinine, urea nitrogen), oxidant/antioxidant imbalance (increased MDA, and increased GST), nitrosative stress (increased nitric oxide), upregulated stress hormone (cortisol) in serum and elevated urokinase in serum and urine (p < .05) as compared to healthy controls. In non-parametric Kendall rank correlation (p < .01), a positive correlation was established between urokinase level and disease severity (urolithiasis). It is concluded that in bovine obstructive urolithiasis, increased oxidative/nitrosative stress, cortisol and urokinase play a significant role. The urokinase can help to understand pathophysiology of bovine urolithiasis because of having positive correlation with disease severity (urolithiasis) and stress markers.

Predictors of renal recovery in renal failure secondary to bilateral obstructive urolithiasis

Objectives

To identify factors predicting renal recovery in patients presenting with renal failure secondary to bilateral obstructing urolithiasis.

Patients and methods

Data from electronic records of consecutive adult patients presenting with bilateral obstructing urolithiasis between January 2007 and April 2011 were retrieved. Ultrasonography of the abdomen, and kidney, ureter, bladder (KUB study) X-ray or abdominal non-contrast computed tomography confirmed the diagnosis. Interventional radiologists placed bilateral nephrostomies. Definitive intervention was planned after reaching nadir creatinine. Renal recovery was defined as nadir creatinine of ⩽2 mg/dL.

Results

In all, 53 patients were assessed, 50 (94.3%) were male, and 18 (33.9%) were aged ⩽40 years. Renal recovery was achieved in 20 patients (37.7%). A symptom duration of ⩽25 days (P < 0.01), absence of hypertension (P = 0.018), maximum renal parenchymal thickness of >16.5 mm (P = 0.001), and haemoglobin >9.85 g/dL (P < 0.01) were significant on unadjusted analysis. Symptom duration of ⩽25 days alone remained significant after adjusted analysis. Symptom duration of ⩽25 days (hazard ratio (HR) 13.83, 95% confidence interval (CI) 4.52–42.26; P < 0.01), parenchymal thickness of ⩾16.5 mm (HR 5.91, 95% CI 1.94–17.99; P = 0.002), and absence of hypertension (HR 9.99, CI 95% 1.32–75.37; P = 0.026) were significantly related to time to nadir creatinine. Symptom duration of ⩽25 days (HR 17.44, 95% CI 2.48–122.79; P = 0.004) alone remained significant after adjusted analysis. A symptom duration of ⩽25 days (P = 0.007) was 22-times more likely to indicate renal recovery.

Conclusions

Shorter symptom duration (⩽25 days) is predictive of renal recovery in renal failure secondary to bilateral obstructive urolithiasis.

Clinical management of dietary induced urolithiasis associated with balanoposthitis in a Boer goat

A Boer-Kajang cross male goat was presented to the Veterinary Hospital, University Malaysia Kelantan with a history of dysuria, hematuria and restlessness. The goat was intensively managed (confined to the pen) and fed with only palm kernel cake for the last three months. Physical examination revealed that the goat was dull, depressed, having an inflamed penis and prepuce with blood stained urine dripping from the penis. The differential diagnoses were obstructive urolithiasis, urinary tract infection and balanoposthitis. Based on the history, clinical signs, physical examination, urinalysis, ultrasonagraphy and feed analysis, the goat was diagnosed with obstructive urolithiasis and balanoposthitis. Treatment was instituted by amputation of the urethral process and retrograde urohydropulsion to relieve the blockade. Sulfadiazine-trimethoprim (Norodine(®)24) 15mg/kg, I.M; flunixin meglumine 2.2mg/kg, I.M; vitamin B complex 1ml/10kg, I.M and ammonium chloride 300mg/kg orally were administered. The goat responded well to treatment and was recovering well during a follow up visit.