1
|
Elbaset MA, Taha DE, Anas M, Elghareeb A, Abouelkheir RT, Ashour R, Sheir KZ, Osman Y. Ureteral wall thickness as a predictor for non-invasive treatment success for steinstrasse. Can we save time? World J Urol 2024; 42:151. [PMID: 38478098 PMCID: PMC10937774 DOI: 10.1007/s00345-024-04874-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/23/2023] [Indexed: 03/17/2024] Open
Abstract
PURPOSE We aimed to define factors affecting the non-invasive overall treatment success (medical expulsive therapy (MET) ± shock wave lithotripsy (SWL)) for uncomplicated ureteral steinstrasse (SS) clearance. METHODS We retrospectively evaluated consecutive patients who underwent SWL for renal stones between 2017 and 2021. Patients with uncomplicated SS were included. All patient's demographic and radiological data, e.g., age, gender, pre-SWL stenting, SS site, type, leading stone size in widest diameter (< 10 mm and ≥ 10 mm), ureteral wall thickness (UWT) in mm against the leading stone were collected. If SS was diagnosed, medical treatment was given for 4 weeks. In case of MET failure, either SWL for the leading stones + MET or direct URS was done. Non-invasive treatment success (SFR) was considered if complete clearance of SS occurred with no complications or the need for invasive intervention. RESULTS A total of 145 patients were included with mean age of 45.9 ± 12.4 years. SFR in case of MET only occurred in 27.9%. Complications happened in 26 patients (17.9%). Non-invasive treatment SFR was achieved in 78 patients (53.8%) totally where SS type I, leading stone size ≤ 10 mm type and decreased UWT around the leading stone increased treatment success. CONCLUSION Ureteral wall thickness is an important factor predicting SS management success. Besides the decreased UWT, non-invasive management should be offered for type I SS with leading stone ≤ 10 mm.
Collapse
Affiliation(s)
- M A Elbaset
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
- Urology Department, Horus University, New Damietta, Egypt.
| | - Diaa-Eldin Taha
- Urology Department, KafrELshiekh University, KafrELshiekh, Egypt
| | - Marwan Anas
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Elghareeb
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Rasha T Abouelkheir
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Rawdy Ashour
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - K Z Sheir
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Osman
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| |
Collapse
|
2
|
Wang M, Zhang Y, Tong H, Liu B, Chen J, Ma Q, Zhang Y. Comparison of ureteral stone measurements for predicting the efficacy of a single session of extracorporeal shockwave lithotripsy: one-, two-, and three-dimensional computed tomography measurements. Urolithiasis 2024; 52:43. [PMID: 38441706 DOI: 10.1007/s00240-024-01538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/28/2024] [Indexed: 03/07/2024]
Abstract
The objective of this study was to compare the value of one-, two- and three-dimensional computed tomography (CT) measurements for predicting the efficacy of a single session of extracorporeal shock wave lithotripsy (ESWL) in patients with a single ureteral stone. A total of 165 patients were included based on the inclusion and exclusion criteria. Different models were constructed using a combination of patients' clinical data and measurements obtained by manual sketching and automated extraction software. Multivariate logistic regression was used to develop the models. Receiver operating characteristic curves were used to assess the performance of the models. There was good interobserver agreement for all measurements in different dimensions (P < 0.001). We also found that hydronephrosis, the largest diameter, the largest area, volume, and mean CT value were significantly greater in the failure group than in the success group (P < 0.01). Furthermore, all sizes and CT measurement values were found to be independent predictors for predicting efficacy after one session of ESWL (P < 0.05). In addition, the multivariate logistic analysis showed that the area under the curve (AUC) for two-dimensional and three-dimensional measurements was superior to that of one-dimensional measurement (P < 0.01). However, when size alone was included as a measurable predictor, there was no significant difference in the AUC among the one-, two-, and three-dimensional measurements (P > 0.05). In summary, after adjusting for clinical data, two- and three-dimensional measurements combining ureteral stone size and CT values were found to be the best predictors of ESWL efficacy, and software-based three-dimensional measurements should be considered to avoid interobserver variability in clinical practice.
Collapse
Affiliation(s)
- Meng Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China.
| | - Yueyue Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Hua Tong
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Bin Liu
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Jueqi Chen
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Qi Ma
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Yingchun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| |
Collapse
|
3
|
Alwan MG, Nima MH, Alquraishi FS, Rashid NR. Deciding on a novel predictive value to gauge how well patients with lower ureteric stones respond to medical expulsive therapy. Urolithiasis 2024; 52:41. [PMID: 38441660 DOI: 10.1007/s00240-024-01549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
This study, conducted over 4 years in Baghdad, Iraq, aimed to determine the importance of ureteric jet assessment in medical expulsive therapy (MET) for distal ureteral stones. A total of 156 patients with distal ureteral stones (≤ 10 mm) participated, and their ureteric jets were observed using a color Doppler scanner before and after 2 weeks of MET. The main focus was the success rate of stone expulsion. Our results showed that 50% of patients had detectable ureteric jets after 2 weeks of MET, and 21.8% experienced successful stone expulsion. After 4 weeks, 23.7% achieved stone expulsion, while 54.5% still had remaining stones. Patients who had a positive baseline ureteric jet were significantly more likely to successfully expel their stones. This study highlights the importance of monitoring ureteric jet movement in MET for distal ureteral stones.
Collapse
Affiliation(s)
| | | | | | - Najah Raham Rashid
- Ibn Sina University for Medical and Pharmaceutical Sciences, Baghdad, Iraq
| |
Collapse
|
4
|
Sahin C, Karaca Y, Sobay R, Arikan O, Uslu M, Bicaklioglu F, Sahinler EB, Sarica K. Ureteral stricture formation after endoscopic removal of obstructing stones: could it be predicted with well-assessed radiological parameters? Urolithiasis 2024; 52:34. [PMID: 38372797 DOI: 10.1007/s00240-024-01530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/06/2024] [Indexed: 02/20/2024]
Abstract
The possible role of well-assessed radiological parameters in the prediction of ureteral stricture formation in cases with impacted obstructive ureteral calculi has been evaluated. 46 adult patients with or without ureteral stricture formation after ureteroscopic stone management were included. In addition to stone size and some certain radiological parameters including ureteral wall thickness (UWT) of the involved ureter at the impacted stone site was also measured and noted on computed tomography (CT) images. Parameters were evaluated in two subgroups of cases, namely: Group 1: patients in whom a ureteral stricture formed after endoscopic stone removal and Group 2: patients normal ureteral anatomy without any stricture formation. The possible relationship between the UWT values and degree of hydronephrosis (HN) with subsequent stricture formation was comparatively evaluated. All of the stones were proximal ureteral calculi in both groups. Both the degree of HN and proximal ureteral diameter (PUD) parenchymal was higher in cases with stricture formation. In addition, mean parenchymal thickness was lower and mean values of UWT measurements at the stone site were 3.70 ± 0.97 mm and 2.17 ± 0.26 mm in Groups 1 and 2, respectively. A cutoff value 2.49 mm for UWT was found to be highly predictive for stricture formation. UWT value calculated at the obstructing stone site was found to be predictive enough for the likelihood of ureteral stricture formation with high sensitivity and specificity . This evaluation along with some other radiological parameters may enable the urologists to follow such cases on this aspect with necessary measures taken.
Collapse
Affiliation(s)
- Cahit Sahin
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Health Sciences University, Istanbul, Turkey.
| | - Yavuz Karaca
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Resul Sobay
- Department of Urology, Umraniye Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Ozgur Arikan
- Department of Urology, Medeniyet University Göztepe Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Mehmet Uslu
- Department of Urology, Kafkas University Health Research and Application Center, Kars, Turkey
| | - Fatih Bicaklioglu
- Department of Urology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Emre Burak Sahinler
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Health Sciences University, Istanbul, Turkey
| | - Kemal Sarica
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Health Sciences University, Istanbul, Turkey
- Department of Urology, Medeniyet University Göztepe Süleyman Yalçın City Hospital, Istanbul, Turkey
- Department of Urology, Biruni University, Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
5
|
Ito H, Sakamaki K, Fukuda T, Yamamichi F, Watanabe T, Tabei T, Inoue T, Matsuzaki J, Kobayashi K. Models to predict the surgical outcome of mini-ECIRS (endoscopic combined intrarenal surgery) for renal and/or ureteral stones. Sci Rep 2023; 13:22848. [PMID: 38129560 PMCID: PMC10739798 DOI: 10.1038/s41598-023-50022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
To establish a safer and more efficient treatment strategy with mini-endoscopic combined intrarenal surgery (ECIRS), the present study aimed to develop models to predict the outcomes of mini-ECIRS in patients with renal and/or ureteral stones. We retrospectively analysed consecutive patients with renal and/or ureteral stones who underwent mini-ECIRS at three Japanese tertiary institutions. Final treatment outcome was evaluated by CT imaging at 1 month postoperatively and stone free (SF) was defined as completely no residual stone or residual stone fragments ≤ 2 mm. Three prognostic models (multiple logistic regression, classification tree analysis, and machine learning-based random forest) were developed to predict surgical outcomes using preoperative clinical factors. Clinical data from 1432 ECIRS were pooled from a database registered at three institutions, and 996 single sessions of mini-ECIRS were analysed in this study. The overall SF rate was 62.3%. The multiple logistic regression model consisted of stone burden (P < 0.001), number of involved calyces (P < 0.001), nephrostomy prior to mini-ECIRS (P = 0.091), and ECOG-PS (P = 0.110), wherein the area under the curve (AUC) was 70.7%. The classification tree analysis consisted of the number of involved calyces with an AUC of 61.7%. The random forest model showed that the top predictive variable was the number of calyces involved, with an AUC of 91.9%. Internal validation revealed that the AUCs for the multiple logistic regression model, classification tree analysis and random forest models were 70.4, 69.6 and 85.9%, respectively. The number of involved calyces, and a smaller stone burden implied a SF outcome. The machine learning-based model showed remarkably high accuracy and may be a promising tool for physicians and patients to obtain proper consent, avoid inefficient surgery, and decide preoperatively on the most efficient treatment strategies, including staged mini-ECIRS.
Collapse
Affiliation(s)
- Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan.
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Kentaro Sakamaki
- Faculty of Health Data Science, Juntendo University, Tokyo, Japan
| | - Tetsuo Fukuda
- Department of Urology, Ohguchi East General Hospital, Yokohama, Japan
| | | | | | - Tadashi Tabei
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Kobe, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi East General Hospital, Yokohama, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| |
Collapse
|
6
|
Liang J, Xie L, Gao H, Yang R, Liu J, Liu C. Factors influencing the efficacy of ultrasound-guided extracorporeal shockwave lithotripsy in the treatment of ureteral stones: a retrospective study. Urolithiasis 2023; 52:15. [PMID: 38117370 DOI: 10.1007/s00240-023-01512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/12/2022] [Indexed: 12/21/2023]
Abstract
The aim of the study was to analyze the factors influencing the efficacy of ultrasound-guided extracorporeal shockwave lithotripsy (ESWL) in the treatment of ureteral stones. The clinical data of 8102 patients (6083 men and 2019 women) who presented with ureteral stones were retrospectively analyzed. All the patients were treated with ultrasound-guided ESWL. The stone-free rate (SFR) was calculated to evaluate the effect of ESWL. The characteristics of the patients and their stones, and the ESWL parameters applied were compared to identify the factors affecting the treatment outcomes. The SFR and that following one ESWL session were 94.6% (7663/8102) and 75.4% (6107/8102), respectively. Multivariate analysis showed that stone location (OR 0.656, p < 0.001), stone size (OR 1.103, p < 0.001), and degree of hydronephrosis (OR 1.952, p < 0.001) independently affected SFR; and age (OR 1.005, p = 0.022), stone location (OR 0.729, p < 0.001), stone size (OR 1.103, p < 0.001), degree of hydronephrosis (OR 1.387, p = 0.001), maximum energy level(OR 0.691, p < 0.001) independently affected SFR following one session. Ultrasound-guided ESWL is effective in all levels of ureteral stones. Large stone size and moderate hydronephrosis are correlated with treatment failure. Ultrasound-guided ESWL may be the first choice for distal ureteral stones.
Collapse
Affiliation(s)
- Junjie Liang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, He Xi District, Tianjin, China
| | - Linguo Xie
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, He Xi District, Tianjin, China
| | - Hongwei Gao
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, He Xi District, Tianjin, China
| | - Rui Yang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, He Xi District, Tianjin, China
| | - Jinling Liu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, He Xi District, Tianjin, China
| | - Chunyu Liu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, He Xi District, Tianjin, China.
| |
Collapse
|
7
|
Nakamae Y, Deguchi R, Nemoto M, Kimura Y, Yamashita S, Kohjimoto Y, Hara I. AI prediction of extracorporeal shock wave lithotripsy outcomes for ureteral stones by machine learning-based analysis with a variety of stone and patient characteristics. Urolithiasis 2023; 52:9. [PMID: 38041695 DOI: 10.1007/s00240-023-01506-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
We propose an artificial intelligence prediction method for extracorporeal shock wave lithotripsy treatment outcomes by analysis of a wide variety of variables. We retrospectively reviewed the records of 171 patients from between January 2009 and November 2019 that underwent shock wave lithotripsy at Wakayama Medical University, Japan, for ureteral stones shown on preoperative non-contrast computed tomography. This prediction method consisted of stone area extraction, stone analyzing factor extraction from non-contrast computed tomography images, and shock wave lithotripsy treatment result prediction by a non-linear support vector machine for analysis of 15 input and automatic measurement factors. Input factors included patient age, skin-to-stone distance, and maximum ureteral wall thickness, and the automatic measurement factors included 11 non-contrast computed tomography image texture factors in the stone area and stone volume. Permutation feature importance was also applied to the artificial intelligence prediction results to analyze the importance of each factor relating to estimate decision grounds. The prediction performance was evaluated by five-fold cross-validation, it obtained 0.742 of the mean area under the receiver operating characteristic curve. The proposed method is shown by these results to have robust data diversity and effective clinical application. As a result of permutation feature importance, some factors that showed high p-values in the significant difference tests were thought to have a high contribution to the proposed prediction method. Future issues include validation using a larger volume of high-resolution clinical non-contrast computed tomography image data and the application of deep learning.
Collapse
Affiliation(s)
- Yukako Nakamae
- Graduate School of Biology-Oriented Science and Technology, Kindai University, Kinokawa City, Japan
| | - Ryusuke Deguchi
- Department of Urology, Wakayama Medical University, Wakayama City, Japan
| | - Mitsutaka Nemoto
- Graduate School of Biology-Oriented Science and Technology, Kindai University, Kinokawa City, Japan.
- Faculty of Biology-Oriented Science and Technology, Kindai University, 930 Nishimitani, Kinokawa City, Wakayama, 649-6493, Japan.
| | - Yuichi Kimura
- Faculty of Informatics, Kindai University, Higashiosaka, Japan
| | - Shimpei Yamashita
- Department of Urology, Wakayama Medical University, Wakayama City, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama City, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama City, Japan
| |
Collapse
|
8
|
Ishikawa K. Pyelonephritis with Anomaly of the Ureter and Calculi. Intern Med 2023; 62:3561-3562. [PMID: 37062743 PMCID: PMC10749808 DOI: 10.2169/internalmedicine.1658-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Affiliation(s)
- Kazuhiro Ishikawa
- Department of Infectious Diseases, Tokyo Medical University Ibaraki Medical Center, Japan
| |
Collapse
|
9
|
Aziz M, Abunayan M, El Shazly M, Salman B, Habous M, Almannie R. Medial deviation of the ureter is a new sign that could predict stone impaction: a pilot study. Int Urol Nephrol 2023; 55:3033-3038. [PMID: 37606748 PMCID: PMC10611609 DOI: 10.1007/s11255-023-03744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To assess the value medial deviation of the ureter at site of ureteric stone as a sign of ureteric stone impaction. PATIENTS AND METHODS All cases with medial deviation of the ureter at site of ureteric stones in our department over 4 years were enrolled in this pilot study. All cases were diagnosed with KUB and non-contrast CT (NCCT). Radiological and ureteroscopic findings were recorded. RESULTS A total of 32 patients with a single impacted stone in the proximal and middle third of the ureter were included in the study. Medial deviation of the ureter at the site of the stone was detected in the upper third of the ureter in 24 (75%) cases and in the middle third in 8 (25%) cases. There were mucosal polyps and mucosal erythema (inflammatory changes) seen by ureteroscopy in all cases (100%). Ureteroscopy was successfully completed with stone fragmentation in 23 (71.8%) patients: 8 of them needed ureteric catheter and 15 required JJ stent insertion. Failure of ureteroscopy with insertion of JJ stent was done in 5 (15.6%) patients. Removal of the stent and ureteroscopy was done after 4 weeks. CONCLUSION We conclude from this study that medial deviation of the ureter is a new reliable radiological sign of ureteric stone impaction.
Collapse
Affiliation(s)
- Mohammed Aziz
- Urology Department, Menoufia University, Shibin El Kom, Egypt
| | - Mohammed Abunayan
- Urology Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | | | - Baher Salman
- Urology Department, Menoufia University, Shibin El Kom, Egypt
| | - Mohammad Habous
- Urology Department, Menoufia University, Shibin El Kom, Egypt
| | - Raed Almannie
- Urology Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
10
|
Uzun E, Arabaci HB, Ceviz K, Koudonas A, Germiyanoglu RC, Senel S. Development of a new scoring system predicting medical expulsive therapy success on 4-10 mm distal ureteral stones: medical expulsive therapy stone score (METSS). Urolithiasis 2023; 52:8. [PMID: 38015235 DOI: 10.1007/s00240-023-01504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
Ureteral stone passage by using medical expulsive therapy (MET) are affected by numerous radiological and clinical parameters. We aimed to construct a scoring system, which would be based on clinical and computed tomography (CT)-derived data, to predict the success of the MET approach. 186 patients presenting to urology clinic or emergency department with unilateral single 4-10 mm distal ureteral stone and who had MET were included. All patients were divided into two groups as the MET-successful group and the MET-unsuccessful group. The success rate of MET was 67.2%. Stone size ≥ 6.5 mm, stone density > 1078 HU, ureteral wall thickness (UWT) > 2.31 mm, ureteral diameter (UD) > 9.24 mm, presence of periureteral stranding (PUS) and presence of diabetes mellitus (DM) were stated as the independent risk factors. Based on the regression coefficients on multivariate logistic regression analysis, 1 point for stone size > 6.5 mm, 2 points for stone density > 1078 HU, 2 points for UWT > 2.31 mm, 3 points for UD > 9.24 mm, 1 point for presence of PUS and 1 point for presence of DM were assigned to patients for each risk factor. Higher medical expulsive therapy stone score (METSS) indicated lower MET success. All patients were classified into three risk groups according to METSS: low risk (0-3 points; success percentage: 92.8%); intermediate risk (4-5 points; success percentage: 60.4%) and high risk (6-10 points; success percentage: 8.3%). The METSS seems to separate successfully the patients with a favorable or adverse constellation of factors.
Collapse
Affiliation(s)
- Emre Uzun
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9, Çankaya, Ankara, Turkey
| | - Hasan Batuhan Arabaci
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9, Çankaya, Ankara, Turkey
| | - Kazim Ceviz
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9, Çankaya, Ankara, Turkey
| | - Antonios Koudonas
- First Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rustu Cankon Germiyanoglu
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9, Çankaya, Ankara, Turkey.
| | - Samet Senel
- Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9, Çankaya, Ankara, Turkey
| |
Collapse
|
11
|
Heijkoop B, Lahoud J, Wong ELH. Endoscopic stone management in an ectopic ureter inserting into the prostatic urethra. BMJ Case Rep 2023; 16:e254927. [PMID: 37770237 PMCID: PMC10546127 DOI: 10.1136/bcr-2023-254927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
We report a case of successful endoscopic stone management in a patient with ectopic ureteric insertion. The patient had a complete duplex collecting system, with the upper moiety ureter inserting ectopically into his prostatic urethra, and an obstructing ureteric stone in the distal portion of the ectopic ureter. This made both characterisation of the patient's anatomy and initial emergency stone management challenging.The case offers several learning points for clinicians who may encounter similar situations. By describing the challenges of managing this patient's presentation, we highlight considerations in imaging interpretation and operative approach that may help the reader manage a similar presentation to their practice. Additionally, we remind the urologist to consider the implications of an ectopic duplex ureter on future procedures, such as transurethral resection of the prostate or radical prostatectomy.
Collapse
Affiliation(s)
- Bridget Heijkoop
- Urology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Urology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - John Lahoud
- Urology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Eddy Lee Hao Wong
- Urology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Urology, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| |
Collapse
|
12
|
Dean NS, Millan B, Uy M, Albers P, Campbell SM, Krambeck AE, De S. Ureteral Wall Thickness Is an Effective Predictor of Ureteral Stone Impaction and Management Outcomes: A Systematic Review and Meta-analysis. J Urol 2023; 210:430-437. [PMID: 37232694 DOI: 10.1097/ju.0000000000003561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Ureteral stone impaction is associated with unfavorable endourological outcomes; however, reliable predictors of stone impaction are limited. We aimed to assess the performance of ureteral wall thickness on noncontrast computed tomography as a predictor of ureteral stone impaction and failure rates of spontaneous stone passage, shock wave lithotripsy, and retrograde guidewire and stent passage. MATERIALS AND METHODS This study was completed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A search was conducted in April 2022 for all adult, human, and English language studies investigating ureteral wall thickness using PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library, Proquest Dissertations & Theses Global, and SCOPUS. A systematic review and meta-analysis using random effects model was conducted. Risk of bias was assessed using the MINORS (Methodological Index for Non-randomized Studies) score. RESULTS Fourteen studies with a pooled population of 2,987 patients were included for quantitative analysis, and 34 studies were included in our qualitative review. Meta-analysis findings suggest that a thinner ureteral wall thickness is associated with more favorable subgroup stone outcomes. Thinner ureteral wall thickness suggests a lack of stone impaction and was associated with improved rates of spontaneous stone passage, successful retrograde guidewire and stent placement, and improved shock wave lithotripsy outcomes. Studies lack a standardized ureteral wall thickness measurement protocol. CONCLUSIONS Ureteral wall thickness is a noninvasive measure that predicts ureteral stone impaction, and thin measurements are predictive of successful outcomes. Variability in measurement methods confirms that a standardized ureteral wall thickness protocol is needed, and the clinical utility of ureteral wall thickness is yet to be determined.
Collapse
Affiliation(s)
- Nicholas S Dean
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
- Department of Urology, Northwestern University, Chicago, Illinois
| | - Braden Millan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael Uy
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Albers
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra M Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Amy E Krambeck
- Department of Urology, Northwestern University, Chicago, Illinois
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
13
|
Kim HJ, Daignault-Newton S, DiBianco JM, Conrado B, Mohammad Jafri S, Seifman B, Konheim J, Dauw CA, Ghani KR. Real-world Practice Stone-free Rates After Ureteroscopy: Variation and Outcomes in a Surgical Collaborative. Eur Urol Focus 2023; 9:773-780. [PMID: 37031097 DOI: 10.1016/j.euf.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Studies assessing the stone-free rate (SFR) after ureteroscopy are limited to expert centers with varied definitions of stone free. Real-world data including community practices related to surgeon characteristics and outcomes are lacking. OBJECTIVE To evaluate the SFR for ureteroscopy and its predictors across diverse surgeons in Michigan. DESIGN, SETTING, AND PARTICIPANTS We assessed the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry for patients with renal or ureteral stones treated with ureteroscopy between 2016 and 2021 who had postoperative imaging. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Stone free was defined as no fragments on imaging reports within 60 d entered by independent data abstractors. Factors associated with being stone free were examined using logistic regression, including annual surgeon volume. We then assessed variation in surgeon-level SFRs adjusted for risk factors. RESULTS AND LIMITATIONS We identified 6487 ureteroscopies from 164 surgeons who treated 2091 (32.2%) renal and 4396 (67.8%) ureteral stones. The overall SFRs were 49.6% (renal) and 72.7% (ureteral). Increasing stone size, lower pole, proximal ureteral location, and multiplicity were associated with not being stone free. Female gender, positive urine culture, use of ureteral access sheath, and postoperative stenting were associated with residual fragments when treating ureteral stones. Adjusted surgeon-level SFRs varied for renal (26.1-72.4%; p < 0.001) and ureteral stones (52.2-90.2%; p < 0.001). Surgeon volume was not a predictor of being stone free for renal stones. Limitations include the lack of imaging in all patients and use of different imaging modalities. CONCLUSIONS The real-world complete SFR after ureteroscopy is suboptimal with substantial surgeon-level variation. Interventions focused on surgical technique refinement are needed to improve outcomes for patients undergoing ureteroscopy and stone intervention. PATIENT SUMMARY Results from a diverse group of community practicing and academic center urologists show that for a large number of patients, it is not possible to be completely stone free after ureteroscopy. There is substantial variation in surgeon outcomes. Quality improvement efforts are needed to address this.
Collapse
Affiliation(s)
- Hyung Joon Kim
- Department of Urology, Konyang University College of Medicine, Daejeon, South Korea.
| | | | | | - Bronson Conrado
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - S Mohammad Jafri
- Department of Urology, Comprehensive Medical Center, Royal Oak, MI, USA
| | - Brian Seifman
- Michigan Institute of Urology, West Bloomfield, MI, USA
| | | | - Casey A Dauw
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
14
|
Katz JE, Abdelrahman L, Nackeeran S, Ezeh U, Visser U, Deane LA. The Development of an Artificial Intelligence Model Based Solely on Computer Tomography Successfully Predicts Which Patients Will Pass Obstructing Ureteral Calculi. Urology 2023; 174:58-63. [PMID: 36736916 DOI: 10.1016/j.urology.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/27/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To improve upon prior attempts to predict which patients will pass their obstructing ureteral stones, we developed a machine learning algorithm to predict the passage of obstructing ureteral stones using only the CT scan at a patient's initial presentation. METHODS We obtained Institutional Review Board approval to conduct a retrospective study by extracting data from all patients with an obstructing 3-10 mm ureteral stone. We included patients with sufficient data to be categorized as having either passed or failed to pass an obstructing ureteral stone. We developed a 3D-convolutional neural network (CNN) model using a dynamic learning rate, the Adam optimizer, and early stopping with 10-fold cross-validation. Using this model, we calculated the area under the curve (AUC) and developed a model confusion matrix, which we compared with a model based only on the largest dimension of the stone. RESULTS A total of 138 patients met inclusion criteria and had adequate images that could be preprocessed and included in the study. Seventy patients failed to pass their ureteral stones, and 68 patients passed their stones. For the 3D-CNN model, the mean AUC was 0.95 with an overall mean sensitivity of 95% and mean specificity of 77%, which outperformed the model based on stone-size. CONCLUSION The 3D-CNN model predicts which patients will pass their obstructing ureteral stones based on CT scan alone and does not require any further measurements. This can provide useful clinical information which may help obviate the need for a delay in care for patients who inevitably require surgical intervention.
Collapse
Affiliation(s)
- Jonathan E Katz
- Department of Urology, Desai Sethi Urology Institute, University of Miami, Miami, FL.
| | | | - Sirpi Nackeeran
- Department of Urology, Desai Sethi Urology Institute, University of Miami, Miami, FL
| | - Uche Ezeh
- Department of Urology, Desai Sethi Urology Institute, University of Miami, Miami, FL
| | - Ubbo Visser
- Department of Computer Science, University of Miami, Miami, FL
| | - Leslie A Deane
- Department of Urology, Desai Sethi Urology Institute, University of Miami, Miami, FL
| |
Collapse
|
15
|
Chiou T, Meagher MF, Berger JH, Chen TT, Sur RL, Bechis SK. Software-Estimated Stone Volume Is Better Predictor of Spontaneous Passage for Acute Nephrolithiasis. J Endourol 2023; 37:85-92. [PMID: 36106604 PMCID: PMC10024069 DOI: 10.1089/end.2022.0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
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 (≥6 mm) and location (proximal/distal). Results: Among 172 patients analyzed, SP occurred in 71 (41%). Patient age (mean 53), gender (38%F), and stone history/side did not differ significantly by SP. Average MD, PD, and SV were significantly smaller among SP stones vs stones requiring surgery (MD 4.3 mm vs 8.0 mm, PD 5.5 mm vs 9.4 mm, and SV 40 mm3 vs 312 mm3; p < 0.001). ROC analysis showed significantly higher area under curve (AUC) for SV for predicting SP by 4 and 6 weeks compared with MD and PD (AUC 0.93 vs 0.86 vs 0.85 4 weeks, p < 0.001; 0.92 vs 0.85 vs 0.86 6 weeks, p < 0.003). AUC difference between SV vs MD was much greater among stones ≥6 mm or proximal stones. Utilizing SV and MD together yielded improved positive predictive value and negative predictive value for SP prediction. Conclusions: SV is a more accurate predictor of SP compared with linear stone dimensions, especially in the setting of larger and/or more proximal stones. Utilizing SV and diameter together yielded improved SP predictions compared with using either metric alone. Prospective studies are indicated to investigate the clinical utility of SV for SP prediction.
Collapse
Affiliation(s)
- Tommy Chiou
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Margaret F. Meagher
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Jonathan H. Berger
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Tony T. Chen
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Roger L. Sur
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Seth K. Bechis
- Department of Urology, University of California San Diego, San Diego, California, USA
| |
Collapse
|
16
|
De Nunzio C, Gallo G, Lombardo R, Franco A, Gravina C, Stira J, Cicione A, Tema G, Cremona A, Pignatelli M, Tubaro A. Ureteral wall thickness and distal ureteral density in patients with residual fragments after Ho:YAG laser semi-rigid ureterolithotripsy. Lasers Med Sci 2022; 38:19. [PMID: 36564640 DOI: 10.1007/s10103-022-03672-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/15/2022] [Indexed: 12/25/2022]
Abstract
Recent data suggest that greater ureteral density distal to ureteral stones or increased ureteral wall thickness (UWT) can predict impacted stones. The aim of our study was to evaluate if patients with residual fragments present with greater ureteral density and larger UWT when compared to stone-free patients. From January onward, a consecutive series of patients undergoing semi rigid Ho:YAG laser ureterolithotripsy (ULT) for ureteral stones were enrolled. A non-contrast enhanced computed tomography (CT) scan was performed before the procedure to evaluate distal ureteral density (DUD) and wall ureteral thickness (UWT) at the site of ureteral stones. Patients with residual fragments were compared to stone-free patients using a matched-pair analysis (1:1 scenario). Cases were matched sequentially using the following criteria: age, gender, body mass index (BMI), stone length, hydronephrosis, location of stones, and mean Hounsfield unit (HU) of the stone. Overall, 160 patients were enrolled, mean age was 57.9 ± 14 years, mean BMI was 25.8 ± 4 kg/m2, mean length of the stone was 10.6 ± 4.9 mm, and mean UWT was 1.4 ± 1.6 mm. A total of 150/160 (94%) patients presented hydronephrosis; mean HU stone was 868 ± 327; mean DUD was 54 ± 17.8 HU. Ureteral distal density (51.7 vs 56.6; p = 0.535) and ureteral distal thickness (1.39 vs 1.54; p = 0.078) were similar in both groups of patients. In our study, the evaluation of distal ureteral density does not predict stone-free rate. Further studies should evaluate the role for preoperative computer tomography in predicting surgery outcome.
Collapse
Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy.
| | - Giacomo Gallo
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Antonio Franco
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Carmen Gravina
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Jordi Stira
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Antonio Cicione
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Giorgia Tema
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Antonio Cremona
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Matteo Pignatelli
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| |
Collapse
|
17
|
Yu Q, Wu Y, Yao L, Jiang R. Upper ureteral calculi complicated with severe hydronephrosis and renal medullary carcinoma in elderly Chinese woman: A case report. Asian J Surg 2022; 46:2166-2167. [PMID: 36450622 DOI: 10.1016/j.asjsur.2022.11.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Qiwei Yu
- Department of Urology, Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Kunshan, Jiangsu Province, 215300, China
| | - Yufan Wu
- Department of Urology, Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Kunshan, Jiangsu Province, 215300, China
| | - Linya Yao
- Department of Urology, Kunshan Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Kunshan, Jiangsu Province, 215300, China
| | - Rilei Jiang
- School of Basic Medicine Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| |
Collapse
|
18
|
Brohi IB, Bhatti MS, Siyal RA, Ali F, Kaimkhani Z, Laghari HR. Efficacy Of Alpha-Adrenergic Receptor Antagonists In The Treatment Of Distal Ureteric Stones: A Paediatric Study. J Ayub Med Coll Abbottabad 2022; 34:807-811. [PMID: 36566404 DOI: 10.55519/jamc-04-10379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND European association of urology (EAU) recommended α- blockers for managing distal ureteric stones in the paediatric population. This paper will help to understand the efficacy of Silodosin as a medical expulsive agent for distal ureteric stones in children, along with the required time duration of stone expulsion. METHODS Forty participants were enrolled and evaluated for complaints, pain severity, associated symptoms, and ultrasound was done to confirm the position and size of the distal stone. Follow-ups were scheduled after every 7 days (1 week) for redo ultrasound and assessment of the stone position. Data was entered and analyzed in the SPSS version 23. To evaluate the significance of data chi-square test was performed, p-value <0.005 was considered significant. RESULTS The minimum and maximum age limits recorded are 3 years and 18 years respectively with a mean age of 9.5±4.5 years and mean stone size was measured as 0.6±0.1 cm. Distribution of stone size indicated the minimum size of 0.4 cm and maximum of 1.0 cm stone in study subjects. Maximum stone expulsion was reported within 14 days or an initial 2 follow-up scans. CONCLUSIONS The efficacy of Silodosin and medical expulsive therapy evaluated the effect on pain management as pain episodes declined with Silodosin treatment and spontaneous passage of stones were increased within the first 14 days of treatment. This study will be a beneficial contribution in literature especially in a developing country population where paediatric urolithiasis is on expansion and ongoing.
Collapse
Affiliation(s)
| | | | - Roshan Ali Siyal
- Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan
| | - Farhan Ali
- Gambat Institute of Medical Sciences, Khairpur
| | | | | |
Collapse
|
19
|
Brodie AC, Johnston TJ, Lloyd P, Hemsworth L, Barabas M, Keoghane SR. Reducing the rate of negative ureteroscopy: predictive factors and the role of preoperative imaging. Ann R Coll Surg Engl 2022; 104:588-593. [PMID: 35133211 PMCID: PMC9433174 DOI: 10.1308/rcsann.2021.0260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate factors that may predict a negative ureteroscopy (URS) performed for ureteric calculi in prestented patients and to assess preoperative imaging in reducing the rate of negative URS. METHODS Data were collected on emergency stent placement for a ureteric calculus from April 2011 to February 2016 (Group A) and October 2016 to October 2019 (Group B). Data included patient demographics, indication for a stent, stone characteristics, baseline bloods, urine culture, readmission, negative URS rate and the use of pre-URS imaging. Multivariate logistic regression was used for statistical analysis. RESULTS Of 257 patients who underwent emergency stent insertion, 251 underwent deferred URS for a ureteric calculus and 6 avoided URS due to pre-URS imaging. Indications for stent were pain (42%), sepsis (39%) and acute kidney injury (19%). Mean stone size was 7.8mm, mean stone density was 699 Hounsfield units (HU) and the stone locations were upper (62%), mid (13%) and lower ureter (25%). The overall negative URS rate was 12%. The negative URS rate was lower in patients with pre-URS imaging compared with those with none, 6% and 14%, respectively (OR=2.33, 95% CI: 0.69-7.56, p=0.2214). Logistic regression analysis indicated stone size as the only significant predictor of a negative URS, where the greater the size of the stone the less likely URS would be negative (β=0.75, 95% CI: 0.60-0.94 p=0.011). CONCLUSIONS Utilising pre-URS imaging can lead to a reduction in negative URS rate. Stone size <5mm appears to be the subgroup most likely to benefit from imaging.
Collapse
Affiliation(s)
| | | | | | | | - M Barabas
- University General Hospital, Czech Republic
| | | |
Collapse
|
20
|
Karkin K, Vuruşkan E, Gürlen G. Laparoscopic transperitoneal ureterolithotomy is an effective and safe method for >15 mm impacted ureteral stones in elderly patients: single center 10-year experience. Eur Rev Med Pharmacol Sci 2022; 26:6671-6677. [PMID: 36196737 DOI: 10.26355/eurrev_202209_29768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim of our study is to investigate the efficacy and safety of laparoscopic ureterolithotomy operation in elderly patients with large and impacted ureteral stones. PATIENTS AND METHODS Between January 2011 and July 2021, 66 elderly patients with impacted, > 15 mm upper and middle ureteral stones underwent laparoscopic ureterolithotomy in our center. The data for all patients were evaluated retrospectively. RESULTS The mean age of the patients was 65 ± 5.43 years. The mean stone size was 20.2 ± 2.5 mm. The mean operation time was 93.6 ± 13.2 minutes. Among patients, 16 (24.2%) had history of unsuccessful shock wave lithotripsy and 12 (18.1%) patients had history of ureterorenoscopy. Stone-free rate was 95.4% in all patients. Modified Clavien grade 1 complications were seen in 18 patients (27.2%), but no significant perioperative and postoperative complications were observed. Urinary extravasation lasting 5, 7 and 9 days was observed in 5 patients (7.5%) who were treated conservatively. The mean hospital stay was 3.4 ± 1.52 days. The patients were asymptomatic at the 6th week post-op follow-up, and no stones were seen on direct X-ray and abdominal ultrasonography. Intravenous urography and non-contrast tomography (NCCT) taken 3 months later did not show any obstruction or stenosis in the ureter. CONCLUSIONS Laparoscopic ureterolithotomy can be considered as the first treatment option for elderly patients with impacted and large ureteral stones, thanks to its high success and acceptable complication rates.
Collapse
Affiliation(s)
- K Karkin
- Health Sciences University, Adana City Training and Research Hospital Urology Clinic, Adana, Turkey.
| | | | | |
Collapse
|
21
|
Deguchi R, Yamashita S, Iwahashi Y, Muraoka S, Kikkawa K, Kohjimoto Y, Hara I. The ratio of CT attenuation values of the ureter above/below ureteral stones is a useful preoperative factor for predicting impacted ureteral stones. Urolithiasis 2022; 50:643-649. [PMID: 35976424 DOI: 10.1007/s00240-022-01354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022]
Abstract
Impacted stones typically make it difficult to perform ureteroscopic lithotripsy (URSL), so it is useful to preoperatively predict such impaction. We focused on CT attenuation values of the ureter above and below the stone ('HU above' and 'HU below') and calculated their ratio (HAB ratio; HU above/HU below ratio). The aim was to investigate whether HAB ratio could predict impacted stones preoperatively. Between 2011 and 2019, 171 patients from our hospital that had URSL for ureteral stones with pretreatment non-contrast computed tomography (NCCT) were retrospectively identified. Ureteral wall thickness (UWT), ureteral wall volume (UWV) and HAB ratio ('HU above' divided by 'HU below') were recorded. Impacted stones were defined as fixed stones that did not move by means of ureteroscopic manipulation or water pressure. Of the 171 procedures, 46 (27%) involved patients with impacted stones. Comparing patient characteristics and stone parameters according to impaction status, factors with significant difference included grade of hydronephrosis, UWT, and HAB ratio (all P < 0.01). Multivariate analysis indicated that significant independent predictors of impacted stones were thicker UWT and lower HAB ratio (all P < 0.01). HAB ratio was a significant preoperative predictor of stone impaction in patients undergoing URSL for ureteral stones. HAB ratio may be informative for selecting the treatment and preoperative preparations.
Collapse
Affiliation(s)
- Ryusuke Deguchi
- Department of Urology, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Shimpei Yamashita
- Department of Urology, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Wakayama, 641-0012, Japan.
| | - Yuya Iwahashi
- Department of Urology, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Satoshi Muraoka
- Department of Urology, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Kazuro Kikkawa
- Department of Urology, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| |
Collapse
|
22
|
Akkaş F, Culha MG, Ayten A, Danacıoğlu YO, Yildiz Ö, İnci E, Guner E, Şahin S. A novel model using computed tomography parameters to predict shock wave lithotripsy success in ureteral stones at different locations. Actas Urol Esp 2022; 46:114-121. [PMID: 35184987 DOI: 10.1016/j.acuroe.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/13/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To combine non-contrast computerized tomography (NCCT)-based parameters with stone and patient characteristics that are already known to affect shock wave lithotripsy (SWL) success and assess this novel model's effectiveness in predicting SWL success for single ureteral stones in different locations. MATERIALS AND METHODS Data of patients treated by SWL for a single ureteral stone between January 2017 and January 2019 were retrospectively reviewed. Demographic parameters of patients and stone characteristics were combined with NCCT-based parameters. NCCT-based parameters included the presence or absence of hydronephrosis, perinephric stranding, periureteral edema, diameter of the proximal ureter, ureteral wall thickness (UWT) at ureteral stone site. The logistic regression method was used for the development of a useful predictive model. Subsequently, the receiver operating curve was used to determine cut-off levels, and a scoring system was developed for prediction of SWL success. RESULTS Stone-free rate was 77,1% (267/346) in the entire cohort. Univariate analysis revealed that age, stone volume, density, perinephric stranding, diameter of proximal ureter, and UWT, were associated with SWL success. In multivariate analysis, proximal ureteral stone location, stone volume, density, and UWT were independent predictors of SWL success. The formula used during logistic regression analysis was: 1/[1 + exp {-8.856 + 0.008 (stone volume) + 0.002 (stone density) + 0.673 (UWT) + 1026 (proximal ureteral stone)}]. The scores of 0, 1, 2, 3 and 4 were associated with 97,8%, 83,4%, 60,8%, 33,2% and 11,1% success rates, respectively, in the prediction model based on these parameters. CONCLUSION We conclude that our model can facilitate decision-making for SWL treatment of ureteral stones in different locations.
Collapse
Affiliation(s)
- F Akkaş
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey.
| | - M G Culha
- University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - A Ayten
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Y O Danacıoğlu
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - Ö Yildiz
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - E İnci
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - E Guner
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | - S Şahin
- University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
| |
Collapse
|
23
|
Carius BM, Long B. Is This Your Stone? Distinguishing Phleboliths and Nephroliths on Imaging in the Emergency Department Setting. J Emerg Med 2022; 62:316-323. [PMID: 35058092 DOI: 10.1016/j.jemermed.2021.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Ureteral stones are a common diagnosis in the emergency department (ED) setting, often found with computed tomography (CT). The high frequency of phleboliths can confound ureteral stone diagnosis on CT imaging. OBJECTIVE This article provides a narrative review of the etiological, epidemiological, and radiological distinctions between ureteral stones and phleboliths for appropriate ED diagnosis and management. DISCUSSION Multiple studies demonstrate phleboliths, benign calcified thrombi largely in pelvic vasculature, are found at frequencies equal to or greater than those of ureteral stones on CT imaging. The calcified foundation of phleboliths and most ureteral stones, as well as the close proximity of the distal ureters to pelvic vasculature, can cause consternation in the proper diagnosis of ureteral stones in the patient with abdominal pain. Radiological findings of circumferential ureteral soft tissue edema ("rim sign") and an irregular tapering soft tissue mass ("comet tail sign") can suggest a ureteral and phlebolith etiology, respectively. These signs demonstrate high specificity but low sensitivity, and clinicians must use history, examination, and secondary signs on imaging to differentiate ureteral stones from phleboliths. CONCLUSIONS Phleboliths are a common finding on CT imaging. Radiological findings of rim sign and comet tail sign may help to differentiate phleboliths and ureteral stones; however, their low sensitivity and inconsistent presentation should prompt greater reliance on other signs of ureteral obstruction to aid in diagnosis of undifferentiated pelvic calcifications.
Collapse
Affiliation(s)
| | - Brit Long
- San Antonio Military Medical Center, Joint Base San Antonio, Fort Sam Houston, Texas
| |
Collapse
|
24
|
Abu Ahmed M, Abu Nasra W, Safadi A, Visoky A, Elias I, Katz R. Fluoroless Ureteroscopy: Experience in More Than 100 Patients. Isr Med Assoc J 2022; 24:47-51. [PMID: 35077045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Ureteroscopy is becoming the primary treatment for ureteral stones. As a standard of care, ureteroscopy is performed under the supervision of fluoroscopy. Recent advances in endourological technology make the need for fluoroscopy questionable. OBJECTIVES To summarize our experience with a no-fluoroscopy technique for selected cases of ureteral stones. METHODS Patients were considered suitable for fluoroless ureteroscopy if they had one or two non-impacted stones, in any location in the ureter, 5-10 mm size, with a normal contralateral renal unit and no urinary tract infection. Procedures were performed using rigid scopes, nitinol baskets/forceps for stone retrieval, and Holmium:YAG laser for lithotripsy. Stents were placed per surgeon's decision. RESULTS During an 18-month period, 103 patients underwent fluoroless ureteroscopy. In 94 patients stones were removed successfully. In six, the stones were pushed to the kidney and treated successfully on a separate session by shock wave lithotripsy. In three patients no stone was found in the ureter. In five patients, miniature perforations in the ureter were noted and an indwelling double J stent was placed. CONCLUSIONS Fluoroless ureteroscopy resulted in a high rate of success. We believe that in selected cases it can be used with minimal adverse events.
Collapse
Affiliation(s)
- Muhamad Abu Ahmed
- Department of Urology, Ziv Medical Center, affiliated with Azrieli Faculty of Medicine in the Galilee, Safed, Israel
| | - Waslem Abu Nasra
- Department of Urology, Ziv Medical Center, affiliated with Azrieli Faculty of Medicine in the Galilee, Safed, Israel
| | - Ali Safadi
- Department of Urology, Ziv Medical Center, affiliated with Azrieli Faculty of Medicine in the Galilee, Safed, Israel
| | - Alexander Visoky
- Department of Urology, Ziv Medical Center, affiliated with Azrieli Faculty of Medicine in the Galilee, Safed, Israel
| | - Ibrahim Elias
- Department of Urology, Ziv Medical Center, affiliated with Azrieli Faculty of Medicine in the Galilee, Safed, Israel
| | - Ran Katz
- Department of Urology, Ziv Medical Center, affiliated with Azrieli Faculty of Medicine in the Galilee, Safed, Israel
| |
Collapse
|
25
|
Yu Q, Liu J, Lin H, Lei P, Fan B. Application of Radiomics Model of CT Images in the Identification of Ureteral Calculus and Phlebolith. Int J Clin Pract 2022; 2022:5478908. [PMID: 36474549 PMCID: PMC9678460 DOI: 10.1155/2022/5478908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/24/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the clinical application of the three-dimensional (3D) radiomics model of the CT image in the diagnosis and identification of ureteral calculus and phlebolith. METHOD Sixty-one cases of ureteral calculus and 61 cases of phlebolith were retrospectively investigated. The enrolled patients were randomly categorized into the training set (n = 86) and the testing set (n = 36) with a ratio of 7 : 3. The plain CT scan images of all samples were manually segmented by the ITK-SNAP software, followed by radiomics analysis through the Analysis Kit software. A total of 1316 texture features were extracted. Then, the maximum correlation minimum redundancy criterion and the least absolute shrinkage and selection operator algorithm were used for texture feature selection. The feature subset with the most predictability was selected to establish the 3D radiomics model. The performance of the model was evaluated by the receiver operating characteristic (ROC) curve, and the area under the ROC curve (AUC) was also calculated. Additionally, the decision curve was used to evaluate the clinical application of the model. RESULTS The 10 selected radiomics features were significantly related to the identification and diagnosis of ureteral calculus and phlebolith. The radiomics model showed good identification efficiency for ureteral calculus and phlebolith in the training set (AUC = 0.98; 95%CI: 0.96-1.00) and testing set (AUC = 0.98; 95%CI: 0.95-1.00). The decision curve thus demonstrated the clinical application of the radiomics model. CONCLUSIONS The 3D radiomics model based on plain CT scan images indicated good performance in the identification and prediction of ureteral calculus and phlebolith and was expected to provide an effective detection method for clinical diagnosis.
Collapse
Affiliation(s)
- Qiuyue Yu
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, China
| | - Jiaqi Liu
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, China
| | - Huashan Lin
- Department of Pharmaceutical Diagnosis, GE Healthcare, Changsha 410005, China
| | - Pinggui Lei
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, China
| | - Bing Fan
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, China
| |
Collapse
|
26
|
Hu J, Yu Y, Liu W, Zhong J, Zhou X, Xi H. CT-Based Predictor for the Success of 12/14-Fr Ureteral Access Sheath Placement. Int J Clin Pract 2022; 2022:3343244. [PMID: 36415697 PMCID: PMC9646298 DOI: 10.1155/2022/3343244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Ureteral access sheaths (UAS) are widely used in retrograde intrarenal surgery (RIRS), and this study aimed to develop a model for predicting the success of UAS placement based on computed tomography. METHODS We analyzed the clinical data of 847 patients who received ureteroscopy. Data on patient and stone characteristics and several computed tomography (CT)-based measurements were collected. A nomogram predicting the success of UAS placement was developed and validated using R software. RESULTS Two hundred and forty-seven patients were identified. Twenty-five patients (10.1%) failed to pass through the UAS. A model with three factors including the short diameter of ureteral calculi, the short diameter of hydronephrosis, and the diameter of the narrowest part of the renal parenchyma was to be strongly practical and had a high area under the curve on internal validation (80.3%). Using a threshold cutoff of 92%, the sensitivity and specificity for predicting UAS placement were 0.35 and 0.92, respectively. CONCLUSION Our study provides a nomogram for predicting the success of UAS placement, and this model could help discriminate patients who are likely to suffer from failed UAS insertion; preoperative ureteral stenting is recommended according to the prediction.
Collapse
Affiliation(s)
- Jieping Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yue Yu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jialei Zhong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haibo Xi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
27
|
Paudel D, Adhikari D, Dhakal RD. Moderate Hydronephrosis among Acute Ureteral Calculus on Ultrasonographic Imaging in a Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2021; 59:1252-1255. [PMID: 35199787 PMCID: PMC9200033 DOI: 10.31729/jnma.6879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/08/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction: Ureteric calculi are lying at any point of ureter from the pelvic ureteric junction to the vesicoureteral junction. If left untreated, ureteropelvic junction obstruction can lead to hydronephrosis. With the improved availability of computed tomography and ultrasound scanning, hydronephrosis is being diagnosed more frequently. The main aim of this study is to find out the prevalence of moderate Hydronephrosis among ureteral calculus on ultrasonography imaging in a tertiary care center of Nepal. Methods: A descriptive cross-sectional study was conducted among 110 acute ureteral calculus cases at Radiodiagnosis and Imaging Department of Chitwan Medical College and Teaching Hospital (CMCTH), Bharatpur from 15th August 2020 to 15th May 2021. The ethical approval was taken from the Institutional Review Committee of same institution. Convenient sampling technique was used to select the participant. The collected data was entered in excel 16 and analysed in Statistical Package for Social Sciences. Point estimate at 95% Confidence Interval was done and frequency and percentage were calculated. Results: Out of the 110 cases of acute ureteral calculus, 31 (28.2%) (19.79-36.60 at 95% Confidence Interval) has moderate hydronephrosis in the ultrasonographic imaging. The mean age of participants was 31.61±8.51 years and male to female ratio was 1.97:1. Vesicoureteric junction was the most common site for ureteric calculus 39 (35.5%). Conclusions: The ultrasound is an easy method to be applied, and a fast one to help and diagnose obstructive hydronephrosis. The main causes of hydronephrosis are kidney stones, followed by ureteral stones, with a moderate degree of hydronephrosis.
Collapse
Affiliation(s)
- Dipesh Paudel
- Department of Radiodiagnosis and Imaging, Chitwan Medical College Teaching Hospital, Bharatpur, Nepal
- Correspondence: Dr. Dipesh Paudel, Department of Radiodiagnosis and Imaging, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan Nepal. , Phone: +977-9851229492
| | - Deepak Adhikari
- Department of Radiodiagnosis and Imaging, Chitwan Medical College Teaching Hospital, Bharatpur, Nepal
| | - Radha Devi Dhakal
- Department of Nursing Faculty, Shree Medical and Technical College, Bharatpur, Nepal
| |
Collapse
|
28
|
Kırlı EA, Bülbül E, Kaygısız O, Yeni S, Can G, Tutar O, Onal B. Ureteral wall thickness at the stone site: A critical predictor of success and complications in children undergoing semi-rigid ureteroscopy. J Pediatr Urol 2021; 17:796.e1-796.e8. [PMID: 34750075 DOI: 10.1016/j.jpurol.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We retrospectively assessed the role of ureteral wall thickness (UWT) at the ureteral stone site in predicting the stone-free status and the complication rates in children undergoing semi-rigid ureterorenoscopy (URS). PATIENTS AND METHODS The children who underwent URS and had undergone non-contrast abdominal computerized tomography before the URS were included in the study. The following protocol was used to determine the outcome. Immediately before removing the stent, all children were evaluated by ultrasound (US) and plain film (KUB) for residual stones in the upper urinary tract and after removing the double J stent, the presence of stone fragments in the ureter was checked with URS. The children were considered stone-free if no residual fragments were identified in radiologic imaging and the evaluation of the ureter by URS. The case was accepted as a failure if any fragments were seen on immediate US, KUB, and/or during URS just after the stent removal. The patients who could not complete the standard primary URS procedure due to stone-related reasons (patients for whom we could not pass the safety guidewire behind the stone and/or the procedure was terminated due to pyuria during the procedure) were also accepted as a failure. The possible factors related to the patient, stone, ureter, and the operation that could affect the outcome and the complications following the URS were evaluated. RESULTS The children's median age was six years (1-17 years). Among the 89 children included in the study, 69 (78%) were stone-free, and 20 (22%) presented residual stone after the first URS session. The ROC analysis revealed that a UWT value of 4.5 mm (sensitivity 60%, specificity 92%) was the optimal cut-off value predictive of the URS outcome. The regression analysis revealed UWT >4.5 mm (p = 0.006) and multiple stone presentation (p = 0.005) as independent risk factors for residual stone. Complications were detected in 15 (17%) children. Thick ureteral wall (p = 0.012) and longer operative time (p = 0.016) were defined as the independent risk factors for complications. DISCUSSION Increased UWT is associated with the adverse outcomes of URS due to tissue hypertrophy, edema, and mucosal bleeding may cause difficulty in removing the stone. The thick ureteral wall might increase the risk of complications due to the necessity of manipulating the instruments or the involuntary forceful use of instruments while removing the stone. CONCLUSION UWT was the only independent variable affecting both increased failure and complication rates in children undergoing URS.
Collapse
Affiliation(s)
- Elif Altınay Kırlı
- Istanbul University- Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Urology, Turkey.
| | - Emre Bülbül
- Istanbul University- Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Urology, Turkey.
| | - Onur Kaygısız
- Uludağ University Faculty of Medicine Department of Urology, Turkey.
| | - Sezgin Yeni
- Uludağ University Faculty of Medicine Department of Urology, Turkey.
| | - Günay Can
- Istanbul University- Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Public Health, Turkey.
| | - Onur Tutar
- Istanbul University- Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Radiology, Turkey.
| | - Bulent Onal
- Istanbul University- Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Urology, Turkey.
| |
Collapse
|
29
|
Miao XY, Miao XN, Ye LY, Cheng H. Image Enhancement Model Based on Deep Learning Applied to the Ureteroscopic Diagnosis of Ureteral Stones during Pregnancy. Comput Math Methods Med 2021; 2021:9548312. [PMID: 34745329 PMCID: PMC8570888 DOI: 10.1155/2021/9548312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the image enhancement model based on deep learning on the effect of ureteroscopy with double J tube placement and drainage on ureteral stones during pregnancy. We compare the clinical effect of ureteroscopy with double J tube placement on pregnancy complicated with ureteral stones and use medical imaging to diagnose the patient's condition and design a treatment plan. METHODS The image enhancement model is constructed using deep learning and implemented for quality improvement in terms of image clarity. In the way, the relationship of the media transmittance and the image with blurring artifacts was established, and the model can estimate the ureteral stone predicted map of each region. Firstly, we proposed the evolution-based detail enhancement method. Then, the feature extraction network is used to capture blurring artifact-related features. Finally, the regression subnetwork is used to predict the media transmittance in the local area. Eighty pregnant patients with ureteral calculi treated in our hospital were selected as the research object and were divided into a test group and a control group according to the random number table method, 40 cases in each group. The test group underwent ureteroscopy double J tube placement, and the control group underwent ureteroscopy lithotripsy. Combined with the ultrasound scan results of the patients before and after the operation, the operation time, time to get out of bed, and hospitalization time of the two groups of patients were compared. The operation success rate and the incidence of complications within 1 month after surgery were counted in the two groups of patients. RESULTS We are able to improve the quality of the images prior to medical diagnosis. The total effective rate of the observation group was 100.0%, which is higher than that of the control group (90.0%). The difference between the two groups was statistically significant (P < 0.05). The adverse reaction rate in the observation group was 5.0%, which was lower than 17.5% in the control group. The difference between the two groups was statistically significant (P < 0.05). The comparison results are then prepared. CONCLUSIONS The image enhancement model based on deep learning is able to improve medical diagnosis which can assist radiologists to better locate the ureteral stones. Based on our method, double J tube placement under ureteroscopy has a significant effect on the treatment of ureteral stones during pregnancy, and it has good safety and is worthy of widespread application.
Collapse
Affiliation(s)
- Xiao-Yan Miao
- Department of Radiation Oncology, The First People's Hospital of Fuyang (Fuyang First Affiliated Hospital of Zhejiang Chinese Medical University Ben Giang College), Hangzhou, China 311400
| | - Xiao-Nan Miao
- Department of Endocrinology, The First People's Hospital of Fuyang (Fuyang First Affiliated Hospital of Zhejiang Chinese Medical University Ben Giang College), Hangzhou, China 311400
| | - Li-Yin Ye
- Department of Urology, The First People's Hospital of Fuyang (Fuyang First Affiliated Hospital of Zhejiang Chinese Medical University Ben Giang College), Hangzhou, China 311400
| | - Hong Cheng
- Department of Ultrasound, The First People's Hospital of Fuyang (Fuyang First Affiliated Hospital of Zhejiang Chinese Medical University Ben Giang College), Hangzhou, China 311400
| |
Collapse
|
30
|
Sert ET, Kokulu K. Relationship between microscopic haematuria and hydronephrosis in urolithiasis. Int J Clin Pract 2021; 75:e14688. [PMID: 34331735 DOI: 10.1111/ijcp.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 11/28/2022] Open
Abstract
AIM The aim of this study was to investigate the relationship between the degree of hydronephrosis and the presence of microscopic haematuria in patients who presented to the emergency department (ED) with ureteral stones. METHODS The records of patients who presented to our ED due to urolithiasis between January 2017 and December 2020 were retrospectively analysed. Patients aged 18 years or older who underwent non-contrast computed tomography (CT abdomen/pelvis) and urinalysis (UA) and were diagnosed with ureteral stones were included in the study. Radiology reports were reviewed for stone size, localisation and degree of hydronephrosis. Patients with and without microscopic haematuria and the degree of hydronephrosis were compared. RESULTS A total of 476 patients were included, which consisted of 391 with microscopic haematuria and 85 without microscopic haematuria. The median stone size was 4.1 mm in the presence of microscopic haematuria and 5.5 mm in the absence of microscopic haematuria. Logistic regression analysis was performed to determine the factors associated with the development of hydronephrosis. Stone size [odds ratio (OR):2.15, 95% confidence interval (CI):1.12-4.16, P < .001), presence of pyuria (OR: 2.58, 95% CI: 1.78-3.48, P < .001) and absence of microscopic haematuria (OR: 1.31, 95% CI 1.04-2.89, P = .017) were identified as risk factors for moderate and severe hydronephrosis. CONCLUSION We consider that imaging studies may be necessary for the diagnosis, and treatment of emergency cases in which microscopic haematuria is not detected in urinalysis since their stone size may be larger and degree of hydronephrosis may be more severe.
Collapse
Affiliation(s)
- Ekrem Taha Sert
- Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey
| | - Kamil Kokulu
- Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey
| |
Collapse
|
31
|
Keskin E, Erdoğan A, Koçak M, Turan A. Relationship between urolithiasis and the fat halo sign. Int J Clin Pract 2021; 75:e14453. [PMID: 34105869 DOI: 10.1111/ijcp.14453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/24/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This study aimed to examine the relationship between urolithiasis and gastric wall fat halo sign (FHS). MATERIALS AND METHOD The data of 382 patients who presented to our clinic with the complaint of flank pain were analyzed retrospectively. According to the results of noncontrast computed tomography, the patients were divided into two groups those with ureteral stones (Group 1) and those without urinary stones (Group 2). The patients' age, gender, weight, height, body mass index (BMI), cholesterol, triglyceride, blood urea nitrogen, creatinine, and gastric wall FHS data were evaluated. RESULTS When Groups 1 and 2 were compared in terms of FHS positivity, FHS was detected in 140 (57.3%) of 244 patients in Group 1 and 24 (17%) of 138 patients in Group 2, indicating a statistically significant difference (P < .001). CONCLUSION A statistically significant relationship was found between urinary stone disease and gastric wall FHS.
Collapse
Affiliation(s)
- Ercüment Keskin
- Department of Urology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Abdullah Erdoğan
- Department of Urology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Mehmet Koçak
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Abdullah Turan
- Department of Urology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| |
Collapse
|
32
|
Bulbul E, Ilki FY, Gultekin MH, Erozenci A, Tutar O, Citgez S, Tansu N, Onal B. Ureteral wall thickness is an independent parameter affecting the success of extracorporeal shock wave lithotripsy treatment in ureteral stones above the iliac crest. Int J Clin Pract 2021; 75:e14264. [PMID: 33891784 DOI: 10.1111/ijcp.14264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To investigate the relationship between ureteral wall thickness (UWT) and other variables of patients who underwent extracorporeal shock wave lithotripsy (SWL) in the primary treatment of the ureteral stone above the iliac crest level. MATERIAL AND METHODS A total of 147 patients aged 18 years and older, who underwent SWL in our clinic between December 2016 and December 2019 for the treatment of ureteral stones above the iliac crest level and had non-contrast enhanced abdominal computed tomography scans before the procedure were included in the clinical study. The results were evaluated at 3 months after SWL. The absence of residual fragments was considered as stone-free status, and the existence of any size residual fragment was considered as treatment failure. RESULTS In our study, the mean age of the patients was 42.4 ± 12.8 years, and the stone-free rate was 92.5%. The median transverse stone size was 7.5 mm (min 2.8-max 15), and the median UWT was 4.2 mm (1-8.7). In the multivariate analysis, UWT (P = .002) and multiple stone presence (P = .027) were found to be independent factors affecting stone-free status. In the receiver operating characteristic curve analysis, the optimal threshold value for UWT was determined as 5.25 mm. CONCLUSIONS We found that UWT was the most important independent variable associated with increased failure in SWL treatment. The presence of multiple stones was another independent factor that increased the failure rates. Using SWL technology through experience accumulated with the mechanical hardware of the machine, we can select patients who are more suitable for this treatment and improve treatment outcomes.
Collapse
Affiliation(s)
- Emre Bulbul
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Fahri Yavuz Ilki
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Mehmet Hamza Gultekin
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ahmet Erozenci
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Onur Tutar
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Sinharib Citgez
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Nejat Tansu
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Bulent Onal
- Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| |
Collapse
|
33
|
Yllade JT, Iglesias Piñeiro F, Osinaga Peredo S, León Mata J, Martull Vázquez R, Sousa A. Anuria secondary to impacted stones in both ureteral meatus. ARCH ESP UROL 2021; 74:541-542. [PMID: 34080576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | | | - Susy Osinaga Peredo
- Servicio de Urología. Hospital Comarcal de Monforte. Monforte de Lemos. Lugo. España
| | - Juan León Mata
- Servicio de Urología. Hospital Comarcal de Monforte. Monforte de Lemos. Lugo. España
| | | | - Alejandro Sousa
- Servicio de Urología. Hospital Comarcal de Monforte. Monforte de Lemos. Lugo. España
| |
Collapse
|
34
|
Sahin MO, Sen V, Irer B, Ongun S, Yildiz G. Can the Hounsfield unit predict the success of medical expulsive therapy using silodosin in 4- to 10-mm distal ureteral stones? Int J Clin Pract 2021; 75:e13844. [PMID: 33231905 DOI: 10.1111/ijcp.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to investigate the predictive ability of the Hounsfield unit (HU) on non-contrast computed tomography (NCCT) for the success of medical expulsive therapy (MET) using silodosin in distal ureteric stones of 4-10 mm. METHODOLOGY The data of patients who underwent MET were retrospectively screened. The patients were divided into two groups as Groups 1 and 2 depending on the presence or absence of stone expulsion, respectively. In addition to HU calculated using the NCCT images, state of the collecting systems, daily fluid intake, number of emergency department visits, and number of pain attacks were compared. RESULTS A total of 88 patients were included in the study. Sixty-four patients (72.7%) expelled the stone after MET while the treatment was not successful in 24 patients (27.3%). The stone area was significantly larger in Group 2 (28.4 ± 15.7 mm2 vs 46.8 ± 16.1 mm2 ; P < .001). NCCT-HU was calculated as 542.5 ± 256.8 for Group 1 and 873.1 ± 335.2 for Group 2, indicating a significant difference (P < .001). The mean number of pain attacks was 1.5 ± 1.2 in Group 1 and 2.2 ± 1.4 in Group 2 (P = .048). The number of visits to the emergency department significantly differed between Groups 1 and 2 (1.1 ± 1.0 and 1.8 ± 1.3, respectively; P = .010). CONCLUSIONS In this study, HU and stone area values calculated on NCCT were found to be effective factors in predicting the treatment success for MET. Therefore, we consider that it would be useful to consider these parameters in the selection of an appropriate treatment for distal ureteric stones.
Collapse
Affiliation(s)
| | - Volkan Sen
- Department of Urology, Manisa State Hospital, Manisa, Turkey
| | - Bora Irer
- Department of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey
| | - Sakir Ongun
- Department of Urology, Balikesir University School of Medicine, Balikesir, Turkey
| | - Guner Yildiz
- Department of Urology, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
35
|
Setia SA, Massie PL, Epsten MJ, Sharma A, Fogg L, Cherullo EE, Chow AK. Renal Forniceal Rupture in the Setting of Obstructing Ureteral Stones: An Analysis of Stone Characterization and Urologic Intervention Pattern. J Endourol 2021; 34:373-378. [PMID: 31950872 DOI: 10.1089/end.2019.0706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction and Objective: Forniceal rupture due to obstructing ureterolithiasis (FROU) is a seldom encountered radiographic finding, but the impact of this diagnosis and influence on stone management has not been well studied in the literature. The purpose of the study is to examine stone characteristics and intervention patterns of patients with radiographic evidence of FROU. Materials and Methods: A retrospective analysis of all patients with radiographic evidence of FROU was compared with patients with obstructing ureteral stones without forniceal ruptures (noFROU). All patients presented to our Emergency Department from January 2015 until December 2018. Data analyzed included patient demographics, clinical presentation, stone characteristics, and management pattern. Primary outcome was need for hospital admission and surgical intervention. Results: Thirty-two patients with FROU (mean age = 45) were compared with 50 patients with noFROU (mean age = 57). Univariate analysis revealed that age, history of diabetes mellitus, history of hypertension, days of symptoms, degree of hydronephrosis, and degree of perinephric stranding were associated with forniceal rupture (p ≤ 0.05). On multivariate analysis, only degree of perinephric stranding remained significant (p ≤ 0.05). Average maximum axial stone diameter in the FROU group was 5.1 mm vs 4.7 mm in the noFROU group (p = 0.66). Overall, 68.8% of stones were located within the distal ureter in the FROU group vs 48.8% in the noFROU group (p = 0.09). There was no difference in hospital admission (FROU 37.5% vs noFROU 44%, p = 0.56) and need for surgical intervention (FROU 50% vs noFROU 48%, p = 0.86). There were no 30-day complications in patients with FROU. Conclusions: Ureteral stone location and size does not seem to impact the presence of FROU. FROU may be an alarming reported finding but its presence does not appear to impact clinical outcomes or affect urological management, including admission or need for urologic intervention.
Collapse
Affiliation(s)
- Shaan A Setia
- Department of Surgery, Division of Urology, Rush University Medical Center, Chicago, Illinois
| | | | | | - Avishkar Sharma
- Department of Radiology, Rush University Medical Center, Chicago, Illinois
| | - Louis Fogg
- Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, Illinois
| | - Edward E Cherullo
- Department of Surgery, Division of Urology, Rush University Medical Center, Chicago, Illinois
| | - Alexander K Chow
- Department of Surgery, Division of Urology, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
36
|
Abstract
RATIONALE High-altitude polycythemia (HAPC) is a common disease in high-altitude areas characterized by excessive erythrocyte proliferation and severe hypoxemia. Recently, the incidence of ureteral calculi has risen. However, cases of ureteral calculi associated with HAPC have not been reported. PATIENT CONCERNS We present the cases of 2 patients (26-year-old female, Case 1; 31-year-old male, Case 2) with HAPC who were born in the lowlands and worked in areas of high altitudes. Both patients were admitted to the hospital with acute severe pain in the ureter as the first symptom. DIAGNOSES Urological examinations confirmed the presence of a ureteral stone. Interestingly, the biochemical tests showed elevated serum uric acid levels, and the calculous component analysis suggested anhydrous uric acid. INTERVENTIONS In the first case, the patient underwent extracorporeal shock wave lithotripsy. In the second case, the patient underwent right ureteroscopy and right ureteral stenting. The patient received postoperative anti-inflammatory, hemostatic, and rehydration therapy. OUTCOMES Both patients recovered well with no recurrences observed upon regular re-examinations. LESSONS Recently, extensive research has demonstrated a significant correlation between hyperuricemia and HAPC. Therefore, we speculated that the occurrence of ureteral calculi among immigrants to the plateau might be related to hyperuricemia associated with HAPC. This case report and literature review highlights that the prevention of ureteral calculi in patients with polycythemia who immigrate to the plateaus from high-altitude areas should be considered. Additionally, the serum uric acid levels and urine pH should be monitored regularly.
Collapse
Affiliation(s)
- Min Yang
- Research Center for High Altitude Medicine, Qinghai University
- Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province
| | - Sen Cui
- Research Center for High Altitude Medicine, Qinghai University
- Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province
- Affiliated Hospital of Qinghai University, Xining
| | - Tanna Wuren
- Research Center for High Altitude Medicine, Qinghai University
- Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province
| | - Kexiong Ma
- Affiliated Hospital of Qinghai University, Xining
| | - Ri-Li Ge
- Research Center for High Altitude Medicine, Qinghai University
- Key Laboratory of Application and Foundation for High Altitude Medicine Research in Qinghai Province
| | - Linhua Ji
- Affiliated Huadu Hospital, Southern Medical University
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| |
Collapse
|
37
|
Wang R, Su Y, Mao C, Li S, You M, Xiang S. Laser lithotripsy for proximal ureteral calculi in adults: can 3D CT texture analysis help predict treatment success? Eur Radiol 2020; 31:3734-3744. [PMID: 33210203 DOI: 10.1007/s00330-020-07498-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 09/27/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To explore whether multiple 3D computed tomography texture analysis (3D-CTTA) parameters can predict the therapeutic effects of holmium: YAG laser lithotripsy (LL) on ureteral calculi. METHODS The files from 94 patients (102 stones) with proximal ureteral calculi treated only by LL at a single institution were retrospectively retrieved from January 2016 to March 2019. According to intra-operative observations and postoperative reexamination, samples were divided into a completely crushed and a non-crushed group. Preoperative non-contrast-enhanced computed tomography (NCCT) images obtained by multiple CT scanners were imported to MaZda software for 3D texture analysis (TA). The CT-derived value of each target stone was measured, and 15 TA parameters were extracted by delineating volumes of interest (VOIs). Receiver operating characteristic (ROC) curves were drawn to determine the optimal critical value of each parameter based on the Youden index, and univariable and multivariable logistic regression analyses determined the significant factors for LL success. RESULTS In univariable analysis, significant differences (p < 0.05) were observed among 7 parameters. In multivariable analysis, Perc.01 3D > 2062 (p = 0.03) and Z-fraction of image in runs (Z-Fraction) > 0.45570 (p = 0.009) were significant independent predictors, with odds ratios (ORs) of 24.204 and 60.329, respectively. In subgroup analysis based on the cutoff value of the CT-derived value (HU = 960), Perc.01 3D (OR = 44.154, 95% CI (2.379, 819.618), p = 0.011) and Z-Fraction (OR = 14.519, 95% CI (2.088, 100.953), p = 0.007) remained statistically significant. CONCLUSIONS The combination of 3D-CTTA parameters and the CT-derived value can be used as a quantitative reference to predict whether a target stone could be completely crushed by LL. KEY POINTS • Computed tomography texture analysis (CTTA) may be helpful in selecting suitable laser lithotripsy (LL) patients. • 3D-CTTA better predicts stone fragility than commonly used methods (such as the CT-derived value). • The combination of CTTA and the CT-derived value can be used as a preoperative quantitative reference.
Collapse
Affiliation(s)
- Rui Wang
- The Clinical School of Medicine, Dali University, 2 Shenghong Road, Gucheng, Dali, 671000, Yunnan Province, China
| | - Yunshan Su
- Department of Radiology, Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China.
| | - Chongwen Mao
- Department of Radiology, Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China
| | - Song Li
- Department of Urology, Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China
| | - Mengjing You
- Department of Radiology, Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China
| | - Shutian Xiang
- Department of Radiology, Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China
| |
Collapse
|
38
|
Bafaraj SM. Significance of nuclear medicine scan in comparison with diethylenetriamine pentaacetic acid and ultrasound imaging in diagnosing renal disorders: An observational study. Medicine (Baltimore) 2020; 99:e22038. [PMID: 32899061 PMCID: PMC7478558 DOI: 10.1097/md.0000000000022038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The effectiveness of diethylenetriamine pentaacetic acid scan is regularly monitored for the assessment of any potential modifications in treatment responses or kidney functions in the pediatric population.This study attempts to compare the usefulness of diethylenetriamine pentaacetic acid and ultrasound imaging of renal disorders among paediatric patients.A retrospective observational study was conducted by enrolling 106 children. The demographic details such as: participant's age, gender, and the history of renal disease of each patient were recorded. Patients were administered radiopharmaceuticals in a fixed dose and were later subjected to computed tomography (CT) scan. The obtained data was analysed using descriptive statistics.Findings indicated increased sensitivity for CT (61.20%); whereas, a major decrease in specificity (23.68%) was observed. Comparison of Single-photon emission CT (SPECT) and CT findings revealed the increased sensitivity (90.90%) for ultrasound; whereas, there was a slight decrease in the specificity (40%) for SPECT. However, SPECT findings show 91% sensitivity among patients with 71.42% positive predictive value. Moreover, an increase in sensitivity for CT (61.20%), followed by a major decrease in specificity (23.68%) was observed.Ultrasonography has been proved to be the safest and the most effective method for the diagnosis and the treatment of most renal disorders, due to the higher predictive value of SPECT scans. It is thus suggested that patients with ureteral calculi should be diagnosed with renal scintigraphy and unenhanced helical computerized tomography.
Collapse
|
39
|
Uçar M, Özen O. The Relationship between Ureteral Obstruction Time and Secondary Signs in Computed Tomography due to Ureteral Stone Obstruction. J Coll Physicians Surg Pak 2020; 30:678-682. [PMID: 32811594 DOI: 10.29271/jcpsp.2020.07.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate the relationship between numerical values obtained using computed tomography (CT) in stone-related urinary obstruction and the duration of obstruction. STUDY DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY Department of Urology, Alanya Alaaddin Keykubat University, Turkey, from January 2018 to September 2019. METHODOLOGY Eighty-three patients were investigated. Commencement of obstruction was defined as time of onset of pain. Cases with less than seven days elapsed between onset of obstruction; and CT were classified as acute obstruction; and those with durations of seven days or more as chronic obstruction. Bilateral renal parenchymal and renal fatty tissue densities were measured in three planes. RESULTS Acute obstruction was present in 53 patients and chronic obstruction in 30. Median renal parenchymal densities in the obstructive and non-obstructive kidneys were 33 and 37 Hounsfield unit (HU), respectively; and median perirenal densities were 99 and 108 HU, the differences being statistically significant (p <0.05). Median perirenal density were 96 HU in acute obstruction and 104.5 HU in chronic obstruction and the difference was statistically significant (p <0.05). No statistically significant difference was determined between renal parenchymal density in acute and chronic obstruction (p >0.05). CONCLUSIONS A low perirenal density on CT indicated prolonged duration of urinary obstruction. Key Words: Computed tomography, Hounsfield unit, Kidney stone, Ureter, Ureteral stone.
Collapse
Affiliation(s)
- Murat Uçar
- Department of Urology, Alanya Alaaddin Keykubat University School of Medicine, Antalya, Turkey
| | - Ozkan Özen
- Department of Radiology, Alanya Alaaddin Keykubat University School of Medicine, Antalya, Turkey
| |
Collapse
|
40
|
Elbaset MA, Elkarta A, Eraky A, Badawy M, Sheir KZ, Shokeir AA. Role of pretreatment Doppler ultrasound in the prediction of factors affecting stone-clearance post-shockwave lithotripsy for ureteral stones: a prospective study. Int Urol Nephrol 2020; 52:1643-1649. [PMID: 32297179 DOI: 10.1007/s11255-020-02465-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/05/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To identify the role of Doppler US (DUS) in the prediction of factors affecting stone-clearance post-SWL for ureteral stones in addition to its role in prediction of pretreatment stone impaction. METHODS We prospectively included patients with ureteric stone for SWL between October 2018 and September 2019. Patient's demographics were collected. Using DUS, resistive index (RI), Δ RI, and ureteric jets were evaluated in both kidneys. Also, stone site, volume, density, skin to stone distance, degree of hydronephrosis, ureteral wall thickness (UWT) were evaluated by NCCT. Univariate and multivariate logistic regression analyses were performed to identify factors that contribute to treatment success. Correlation between ipsilateral RI with other radiological findings predicting stone impaction was done. RESULTS A total of 93 patients were finally included (61 males and 32 females). The mean age was 31.4 ± 7.7 years. The success rate (absence of significant residuals post 1 month by NCCT) was 51.6%. In multivariate analysis, the presence of ureteric jet, ipsilateral lower RI, and ipsilateral lower UWT were independent factors for treatment success (P = 0.0001, 0.002, and 0.03, respectively). Also, ipsilateral absence of ureteric jet, increased hydronephrosis, and increased UWT were correlated with higher ipsilateral RI in prediction of stone impaction. Ipsilateral higher RI was found to achieve higher accuracy in stone impaction prediction (PPV of 94.8%). CONCLUSION Pretreatment DUS is a useful, non-invasive with a less irradiative tool for prediction of stone impaction and stone-free rate post-SWL for ureteric stones.
Collapse
Affiliation(s)
- M A Elbaset
- Urology Department, Clinical Fellow in Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Ahmed Elkarta
- Urology Department, Clinical Fellow in Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Eraky
- Urology Department, University Hospital Schleswig Holstein-Kiel, Kiel, Germany
| | - Mohamed Badawy
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - K Z Sheir
- Urology Department, Clinical Fellow in Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A A Shokeir
- Urology Department, Clinical Fellow in Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| |
Collapse
|
41
|
Palka J, Farooq Z, Anderson BG. Safety of retrograde pyelography for infected ureteral stones. Can J Urol 2020; 27:10130-10134. [PMID: 32065871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Initial management of obstructing ureteral stones with concomitant urinary tract infection (UTI) includes prompt renal decompression and antibiotics. Some urologists theorize that performing retrograde pyelography (RGP) at the time of ureteral stent placement may cause pyelovenous backflow of bacteria thereby worsening clinical outcomes. We compared outcomes in patients with infected ureteral stones who underwent RGP versus no RGP prior to stent placement. MATERIALS AND METHODS A retrospective chart review was conducted involving patients who presented between 2015 and 2017 with an obstructing ureteral stone and associated UTI. Computed tomography scans were evaluated for stone size and location. Operative reports were reviewed to determine whether the patient underwent RGP at time of ureteral stent placement. Demographics, perioperative information, intensive care unit (ICU) admission rate, and length of stay (LOS) were compared. RESULTS Seventy-two patients were identified and stratified by severity of condition at presentation, including UTI without sepsis (n = 18), sepsis (n = 32), severe sepsis (n = 11), and septic shock (n = 11). Forty-three patients underwent RGP at the time of stent placement, and 29 did not. Between both patient cohorts, statistical analysis revealed no significant difference in postoperative ICU admission rate (p = 0.35) or LOS for patients with UTI without sepsis (p = 0.17), sepsis (p = 0.45), severe sepsis (p = 0.66), and septic shock (p = 0.25). CONCLUSION The use of RGP prior to ureteral stent placement for an obstructing ureteral stone with concomitant UTI was not associated with unfavorable clinical outcomes in our retrospective series. While these findings support the safety of RGP in this setting, prospective trials are warranted.
Collapse
Affiliation(s)
- Joshua Palka
- Department of Urology, Detroit Medical Center, Detroit, Michigan, USA
| | | | | |
Collapse
|
42
|
Aleksandrova KA, Serova NS, Rudenko VI, Gazimiev MA, Kapanadze LB, Fiev DN, Miskaryan TI. [Clinical value of CT-perfusion in patients with ureteric stones]. Urologiia 2019:38-43. [PMID: 31808630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Urinary stone disease is one of the most significant urologic diseases, since its prevalence increases annually, which makes it necessary to study and improve effective preventive measures, diagnostic methods and to implement new treatment interventions. AIM to study changes in blood flow in the renal cortex and medulla in patients with ureteral stones using CT perfusion. MATERIALS AND METHODS From 2017 to 2019, a total of 53 patients with upper ureteric stones were evaluated at the Russian-Japanese Center for Imaging and the Institute of Urology and Reproductive Health of the FGAOU VO I.M. Sechenov First Moscow State Medical University. Preoperatively, all patients underwent CT perfusion. The study was performed on a Toshiba Aquilion One 640 in volume mode with a slice thickness of 0.5 mm. In this study, blood flow changes were evaluated depending on the degree of dilatation of collecting system. RESULTS In patients without dilatation of the collecting system, the average values of cortical and medullary blood flow and blood volume were within normal values. In patients with a dilatation of collecting system, there were significant differences cortical and medullary blood flow between the affected renal unit and contralateral side (27% and 34%, respectively). A decrease in cortical and medullar perfusion by 55% and 58%, respectively, in patients with the dilatation of calyxes was more pronounced in comparison with a decrease in perfusion in patients with the dilatation of only the ureter and pelvis. CONCLUSION CT perfusion performed on the 640-slice CT scan allows an objective assessment of changes in renal blood flow in patients with ureteric stones.
Collapse
Affiliation(s)
- K A Aleksandrova
- Department of X-ray Diagnostics and Radiation Therapy of Medical Faculty, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Institute of Urology and Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - N S Serova
- Department of X-ray Diagnostics and Radiation Therapy of Medical Faculty, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Institute of Urology and Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - V I Rudenko
- Department of X-ray Diagnostics and Radiation Therapy of Medical Faculty, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Institute of Urology and Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Gazimiev
- Department of X-ray Diagnostics and Radiation Therapy of Medical Faculty, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Institute of Urology and Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - L B Kapanadze
- Department of X-ray Diagnostics and Radiation Therapy of Medical Faculty, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Institute of Urology and Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - D N Fiev
- Department of X-ray Diagnostics and Radiation Therapy of Medical Faculty, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Institute of Urology and Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - T I Miskaryan
- Department of X-ray Diagnostics and Radiation Therapy of Medical Faculty, FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Institute of Urology and Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| |
Collapse
|
43
|
Kurtz MP. Fluoroless or fluoro less. J Pediatr Urol 2019; 15:591-592. [PMID: 31494043 DOI: 10.1016/j.jpurol.2019.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Michael P Kurtz
- Boston Children's Hospital, Department of Urology, 300 Longwood Avenue, Hunnewell 3, Boston, MA, 02115, USA.
| |
Collapse
|
44
|
NICE Guideline - Renal and ureteric stones: assessment and management: NICE (2019) Renal and ureteric stones: assessment and management. BJU Int 2019; 123:220-32. [PMID: 30656839 DOI: 10.1111/bju.14654] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
45
|
Abualruz AR, Dyer RB. A "dumbbell" vesicourethral stone. Abdom Radiol (NY) 2019; 44:2951-2952. [PMID: 31073718 DOI: 10.1007/s00261-019-02058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Abdul Rahman Abualruz
- Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA.
| | - Raymond B Dyer
- Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
| |
Collapse
|
46
|
Deb S, Lu Z, Kuganesan A, Lau KK. Ray sum image: its efficacy in renal tract calculus detection. Clin Radiol 2019; 74:650.e7-650.e12. [PMID: 31036313 DOI: 10.1016/j.crad.2019.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/28/2019] [Indexed: 11/19/2022]
Abstract
AIM To determine the efficacy of a ray sum image derived from computed tomography of the kidneys, ureters and bladder (CT KUB) in detecting renal tract calculi and whether this can replace the baseline abdominal radiograph (AXR). MATERIALS AND METHODS This is a retrospective study performed at a tertiary referral centre examining adult patients referred for urolithiasis who had undergone AXR within 24 hours of the diagnostic CT KUB. AXR and ray sum image for calculus visibility were reviewed blindly by two readers. Anteroposterior thickness of the patient, presence of excess gas/faecal material, calculus size, location, and mean attenuation were analysed to determine effect on the AXR and ray sum sensitivity. RESULTS One hundred and fifty-two calculi were examined with ray sum image sensitivity of 44% (95% confidence interval [CI]: 36-52) and AXR 30% (95% CI: 22-38). Calculus size and mean attenuation significantly affected sensitivities of both ray sum and AXR. There was substantial agreement between the two techniques with κ(Kappa)=0.70 (95% CI: 0.58-0.81, p<0.001). CONCLUSION Ray sum image as a post-processed image derived from CT KUB dataset may be a viable alternative to the baseline AXR in patients with CT proven urolithiasis. This would reduce patient radiation dose and streamline workflow in busy radiology and emergency departments.
Collapse
Affiliation(s)
- S Deb
- Department of Diagnostic Imaging, Monash Health, Victoria, Australia.
| | - Z Lu
- Monash Pathology, Monash Health, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - A Kuganesan
- Department of Diagnostic Imaging, Monash Health, Victoria, Australia
| | - K K Lau
- Department of Diagnostic Imaging, Monash Health, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| |
Collapse
|
47
|
Cui Y, Chen J, Zeng F, Liu P, Hu J, Li H, Li C, Cheng X, Chen M, Li Y, Li Y, Yang Z, Chen Z, Chand H, Chen H, Zu X. Tamsulosin as a Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Urol 2019; 201:950-955. [PMID: 30694932 DOI: 10.1097/ju.0000000000000029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Tamsulosin is widely administered as a medical expulsive therapy to facilitate stone passage in patients with ureteral calculi. Recently several large, multicenter, randomized controlled trials revealed conflicting results, which led to considerable uncertainty about the efficacy of tamsulosin in the management of ureteral stones. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of tamsulosin in the management of ureteral stones. MATERIALS AND METHODS We searched MEDLINE®, Embase®, Web of Knowledge, Google Scholar™ and the Cochrane Central Search Library databases up to June 2018. Two reviewers independently evaluated eligible randomized controlled trials of the efficacy of tamsulosin to treat ureteral stones. Study quality was assessed with the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Subgroup analyses were performed to explore heterogeneity. RESULTS Included in study were 56 randomized controlled trials in a total of 9,395 patients. The observed treatment effect indicated that tamsulosin was associated with a higher stone expulsion rate (RR 1.44, 95% CI 1.35-1.55, p <0.01), a shorter stone expulsion time (weighted mean difference -0.73, 95% CI -1.00--0.45, p <0.01), a lesser incidence of ureteral colic (weighted mean difference -0.81, 95% CI -1.24--0.39, p <0.01) and fewer incidences of requiring subsequent intervention (RR 0.68, 95% CI 0.50-0.93, p = 0.017). Treatment with tamsulosin did not differ from a control group in the overall incidence of side effects (RR 1.14, 95% CI 0.86-1.51, p = 0.36). On subgroup analysis we observed a significant benefit in the stone expulsion rate for tamsulosin among patients with stones greater than 5 mm (RR 1.44, 95% CI 1.22-1.68, p <0.01) but no effect for stones 5 mm or less (RR 1.08, 95% CI 0.99-1.68, p <0.01). CONCLUSIONS Our current meta-analysis results indicate that tamsulosin is effective and relatively safe in patients with ureteral stone as a medical expulsive therapy to facilitate stone passage. It is suggested to administer it selectively in patients with 5 to 10 mm ureteral stones.
Collapse
Affiliation(s)
- Yu Cui
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Feng Zeng
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Peihua Liu
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Jiao Hu
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Huihuang Li
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Chao Li
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Xu Cheng
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Minfeng Chen
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Yangle Li
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Yang Li
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Zhongqing Yang
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Zhiyong Chen
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Harripersaud Chand
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University , Changsha , China
| |
Collapse
|
48
|
Hu M, Zhong X, Cui X, Xu X, Zhang Z, Guan L, Feng Q, Huang Y, Hu W. Development and validation of a risk-prediction nomogram for patients with ureteral calculi associated with urosepsis: A retrospective analysis. PLoS One 2018; 13:e0201515. [PMID: 30071061 PMCID: PMC6072035 DOI: 10.1371/journal.pone.0201515] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/17/2018] [Indexed: 01/21/2023] Open
Abstract
Objectives To develop and validate an individualized nomogram to predict probability of patients with ureteral calculi developing into urosepsis. Methods The clinical data of 747 patients with ureteral calculi who were admitted from June 2013 to December 2015 in Affiliated Nanhai Hospital of Southern Medical University were selected and included in the development group, while 317 ureteral calculi patients who were admitted from January 2016 to December 2016 were included in the validation group. The independent risk factors of ureteral calculi associated with urosepsis were screened using univariate and multivariate logistic regression analyses. The corresponding nomogram prediction model was drawn according to the regression coefficients. The area under the receiver operating characteristic curves and the GiViTI calibration belts were used to estimate the discrimination and calibration of the prediction model, respectively. Results Multivariate logistic regression analysis showed that the five risk factors of gender, mean computed tomography(CT) attenuation value of hydronephrosis, functional solitary kidney, urine white blood cell(WBC) count and urine nitrite were independent risk factors of ureteral calculi associated with urosepsis. The areas under the receiver operating characteristic curve of the development group and validation group were 0.913 and 0.874 respectively, suggesting that the new prediction model had good discrimination capacity. P-values of the GiViTI calibration test of the two groups were 0.247 and 0.176 respectively, and the 95% CIs of GiViTI calibration belt in both groups did not cross the diagonal bisector line. Therefore the predicted probability of the model was consistent with the actual probability which suggested that the calibration of the prediction model in both groups were perfect and prediction model had strong concordance performance. Conclusion The individualized prediction model for patients with ureteral calculi can facilitate improved screening and early identification of patients having higher risk of urosepsis.
Collapse
Affiliation(s)
- Ming Hu
- Department of Urology, Guangzhou School of Clinical Medicine, Southern Medical University (Guangzhou General Hospital of Guangzhou Military Region), Guangzhou, Guangdong, P.R. China
- Department of Urology, Affiliated Nanhai Hospital, Southern Medical University (People’s Hospital of Nanhai District), Foshan, Guangdong, P.R. China
| | - Xintai Zhong
- Department of Urology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, P.R. China
| | - Xuejiang Cui
- Department of Urology, Affiliated Nanhai Hospital, Southern Medical University (People’s Hospital of Nanhai District), Foshan, Guangdong, P.R. China
| | - Xun Xu
- Department of Urology, Affiliated Nanhai Hospital, Southern Medical University (People’s Hospital of Nanhai District), Foshan, Guangdong, P.R. China
| | - Zhanying Zhang
- Department of Urology, Affiliated Nanhai Hospital, Southern Medical University (People’s Hospital of Nanhai District), Foshan, Guangdong, P.R. China
| | - Lixian Guan
- Department of Urology, Affiliated Nanhai Hospital, Southern Medical University (People’s Hospital of Nanhai District), Foshan, Guangdong, P.R. China
| | - Quanyao Feng
- Department of Urology, Affiliated Nanhai Hospital, Southern Medical University (People’s Hospital of Nanhai District), Foshan, Guangdong, P.R. China
| | - Yiheng Huang
- Department of Urology, Affiliated Nanhai Hospital, Southern Medical University (People’s Hospital of Nanhai District), Foshan, Guangdong, P.R. China
| | - Weilie Hu
- Department of Urology, Guangzhou School of Clinical Medicine, Southern Medical University (Guangzhou General Hospital of Guangzhou Military Region), Guangzhou, Guangdong, P.R. China
- * E-mail:
| |
Collapse
|
49
|
Abstract
We would like to submit an interesting image of ureteric steinstrasse post lithotripsy procedure resembling a cobble stone street.
Collapse
Affiliation(s)
- Aditi Sullere
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India
| | - Binit Sureka
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India.
| | | |
Collapse
|
50
|
Gharib T, Mohey A, Fathi A, Alhefnawy M, Alazaby H, Eldakhakhny A. Comparative Study between Silodosin and Tamsulosin in Expectant Therapy of Distal Ureteral Stones. Urol Int 2018; 101:161-166. [PMID: 30025399 DOI: 10.1159/000490623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/02/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of silodosin against tamsulosin as medical expulsion therapeutic agent in stone lower 1/3rd ureter. PATIENTS AND METHODS One hundred fifty patients divided equally into 2 groups I and II received silodosin 8 mg and tamsulosin 0.4 mg respectively. Patients aged 18 years or older having single unilateral stone 10 mm or less were included in the study. Patients with bilateral or multiple stones, marked hydronephrosis, previous open or endoscopic surgery and having urinary infection were excluded. Patients were followed weekly for 4 weeks by ultrasonography, plain radiography of the urinary tract and CT of the urinary tract when indicated. RESULTS Silodosin showed better results against tamsulosin as stone expulsion rate in silodosin and tamsulosin groups was 82.4 and 61.5% respectively with significant difference (p = 0.007). Also, the stone expulsion time was significantly lower in silodosin against tamsulosin groups as it was 9.4 ± 3.8 vs. 12.7 ± 5.1 days in group I and II respectively (p = 0.001). The adverse effects were comparable with non-significant more retrograde ejaculation in the silodosin group. CONCLUSION Silodosin showed better efficacy in the stone expulsion rate and time with comparable safety of both drugs, with nonsignificant more retrograde ejaculation in silodosin.
Collapse
|