Analysis of risk factors for urinary tract infection in pregnant women with acute renal colic after indwelling ureteral D-J tube / 中华全科医师杂志

Objective:To investigate the risk factors related to urinary tract infection after indwelling ureteral D-J tube in pregnant women with acute renal colic.Methods:Clinical data of 109 pregnant women with acute renal colic undergoing indwelling ureteral D-J tube in emergency department of Taizhou Hospital or Enze Hospital from January 2008 to December 2019 were retrospectively analyzed. There were 31 cases (28.4%) with urinary tract infection after discharge and before delivery (infection group) and 78 cases without infection (non-infected group). Univariate and multivariate logistic regression analyses were used to evaluate the risk factors of urinary tract infection after ureteral D-J tube insertion.Results:In 109 patients the average age was 28 (25,33) years, the average gestational age was 26 (21,31)weeks, and the average body mass index (BMI) was 24.84 (22.60,27.43) kg/m 2. Compared with the non-infected group, the infection group had a higher rate of positive urine culture [38.7%(12/31) vs. 15.4%(12/78), χ2=6.56, P=0.010] and diabetes [45.2%(14/31) vs. 11.5%(9/78), χ2=13.86, P<0.001], and a lower gestational age [23(20,28) vs.27(21,32) weeks, Mann-Whitney U test, P=0.006]. Multivariate analysis showed that diabetes( OR=7.739,95 %CI:2.579-23.223, P<0.001), positive urine culture( OR=3.249,95 %CI:1.131-9.330, P=0.029), and gestational age( OR=0.201,95 %CI:0.042-0.955, P=0.044) were independent risk factors for urinary tract infection in pregnant women with acute renal colic after ureteral D-J tube insertion. Conclusion:History of diabetes, gestational age, and positive preoperative urine culture are risk factors for urinary tract infection after ureteral D-J tube insertion in pregnant women with acute renal colic.

Hospitalización en paciente con cólico renal: Caracterización clínico-epidemiológica en el Hospital Clínico Herminda Martín, período marzo 2014 - marzo 2019 / Hospitalization in a patient with renal colic: Clinical-epidemiological characterization at the Herminda Martín Clinical Hospital, period March 2014 - March 2019

INTRODUCCIÓN: El cólico renal es una condición médica común en los servicios de urgencia. Representa la manifestación clínica más frecuente de urolitiasis, cuya patogenia es multifactorial, con tasas de prevalencia varía de 1% a 20% y una recurrencia a 10 años del 42% al 50%. OBJETIVO: Establecer el perfil clínico-epidemiológico, como también el diagnóstico y manejo de los pacientes hospitalizados por cólico renal en el Hospital Clínico Herminda Martín (HCHCM). MATERIAL Y MÉTODO: Estudio descriptivo retrospectivo en pacientes hospitalizados con diagnóstico de cólico renal en el HCHM de Chillán en el período marzo 2014-marzo 2019. Se estudiaron las variables: sexo, edad, presentación clínica de ingreso, factores de riesgo asociados, motivo de hospitalización, resultados imagenológicos y manejo clínico. Resultados. El 52,45% correspondió a pacientes de sexo masculino, encontrándose la mayor cantidad de pacientes en el intervalo de 40-49 años. La obesidad, antecedente de urolitiasis e hipertensión arterial fueron las patologías asociadas más frecuentes. En la mayoría de los pacientes, el motivo de la hospitalización fue la refractariedad al tratamiento analgésico, alcanzando un 86,76%. El 56,37% de los pacientes recibió manejo médico expulsivo y a un 19,11% de los pacientes se le realizó una intervención quirúrgica durante la hospitalización. CONCLUSIÓN: El perfil de éstos pacientes no sólo permite establecer medidas que podrían evitar un evento litiásico, sino que además se demuestra la necesidad de realizar un manejo óptimo que puede evitar reconsultas, sobrecarga de los servicios de urgencia, aumento de días cama y complicaciones.

INTRODUCTION: Renal colic is a common condition in the emergency department. It represents the most frequent clinical manifestation of urolithiasis, whose prevalence rate varies between 1% to 20%. Its pathogenesis is multifactorial, with a recurrence of 10 years from 42-50%. OBJECTIVE: Establish the clinical-epidemiological profile, as well as the diagnosis and management of patients hospitalized for renal colic at the Herminda Martín Clinical Hospital(HCHM). MATERIALS AND METHODS: A retrospective descriptive study of hospitalized patients diagnosed with renal colic at the HCHM, March 2014-March 2019, the variables were studied: sex, age, the clinical presentation of admission, associated risk factors, the reason for hospitalization, imaging results, and management. Results: 52.45% were male patients, with the highest number of patients in the range of 40-49 years. Obesity, a history of urolithiasis and hypertension, occurred more frequently within the associated pathologies. In most patients, refractable to analgesic treatment was the reason for hospitalization, reaching 86.76%. 56.37% of patients received expulsion medical management, and 19.11% of patientshad surgeryduring hospitalization. CONCLUSION: The profile of these patients not only allows them to establish measures that could prevent a lithiasis event but also shows the need for effective management of patients who can avoid reconsults, an overload of emergency services, increasedbed days and complications

Características y evolución de pacientes con litiasis urinaria en emergencia de un hospital terciario / Characteristics And Evolution Of Patients With Urinary Lithiasis In A Tertiary Hospital Emergency

Antecedentes: La sintomatología y complicaciones de litiasis urinaria son una causa frecuente de atención en emergencia. Objetivos: Determinar características y evolución de pacientes con litiasis urinaria atendidos en el servicio de emergencia de un hospital terciario de la seguridad social. Métodos: Estudio observacional realizado en el hospital Rebagliati Lima-Perú, durante el primer trimestre 2019. Se evaluó variables sociodemográficas, de tiempo e indicadores de emergencia del sistema estadístico institucional, realizando estadística descriptiva con IBM SPSS 25.0. Resultados: Se registraron 583 atenciones por litiasis urinaria (194 por mes), correspondiendo al 14% de la patología genito-urinaria vista en el servicio evaluado. 55% de sexo masculino, edad promedio 48 años (rango 14 a 92). Atendidos principalmente por tópico de cirugía y de prioridad 3, causas más frecuentes dolor, infección y hematuria. Tiempo de primera atención 4,8 horas, saliendo de alta el 70%. Se admitió a salas de observación 10,5% con estancia promedio de 77 horas (3,2 días), siendo hospitalizada 51%, de alta 31%, operada 3% y falleció 2%. Conclusión: La litiasis urinaria se presenta en 1 de cada 7 atenciones de patología genitourinaria del servicio de emergencia evaluado, predominando en varones, de edad media, el 10% es admitido a sala de observación, con corta estancia y baja mortalidad.

Background: The symptoms and complications of urinary lithiasis are a frequent cause of emergency care. Objectives: To determine characteristics and evolution of patients with urinary lithiasis attended in the emergency room of a tertiary social security hospital. Methods: Observational study carried out at the Rebagliati hospital Lima-Peru, during the first quarter of 2019. Sociodemographic variables, time and emergency indicators of the institutional statistical system were evaluated, performing descriptive statistics with IBM SPSS 25.0. Results: 583 attentions for urinary lithiasis (194 per month) were registered, corresponding to 14% of the genito-urinary pathology seen in the evaluated service. 55% male, average age 48 years (range 14 to 92). Mainly attended by surgical topic and priority 3, most frequent causes pain, infection and hematuria. Time of first attention 4.8 hours, leaving 70% of discharge. Observation rooms were admitted to 10.5% with an average stay of 77 hours (3.2 days), with 51% hospitalized, discharge 31%, operated 3% and 2% died. Conclusion: Urinary lithiasis occurs in 1 out of 7 genitourinary pathologies of the emergency room evaluated, predominantly in middle-aged men, 10% are admitted to the observation room, with a short stay and low mortality.

External physical vibration lithecbole in treatment of ureteral calculi with renal colic used different positions:a prospective multicenter randomized controlled clinical study / 中华泌尿外科杂志

Objective To evaluate the efficacy and safety of different positions external physical vibration lithecbole (EPVL) therapy for ureteral calculi related renal colic.Methods This study was a prospective multicenter randomized controlled trial.The inclusion criteria was that patients volunteered to participate in the trial and signed informed consent,patients' age ranged from 18-65 years old,ureteral calculi related with renal colic,stone diameter was less than 7 mm,patients were not treated with analgesia,antispasmodic drugs.The exclusion criteria was that combination of severe urinary tract infection,severe hydronephrosis,urinary malformation,severe hypertension,history of cerebrovascular disease,vital organ dysfunction,obesity (BMI ＞ 35 kg/m2),history of ureteral calculi exceeded 2 months,abnormal blood coagulation.Patients were randomized into observation group and control group using random number table method.The observation group and the control group were placed on the physical vibration stone arranging machine with head low foot high position and head high foot low position respectively.The inclination angle was 24°.The secondary vibrator vibrated for 6 minutes,then the patient took the prone position and opened the main,the secondary vibrator.The treatment is completed after 6 minutes of vibration.The analgesic effect,stone removal,follow-up effects and adverse reactions in the two groups was compared.We defined the pain relief rate as(VAS score before treatment-VAS score after treatment)/VAS score before treatment × 100％.Results A total of 100 patients were included in the study,50 in the observation group and 50 in the control group.There were no statistical difference in the age of the two groups [(41.8 ± 11.7) years and (46.6 ± 13.9 years)],gender distribution [37(male)/13 (female) and 42(male)/8(female)],location of stones (in the observation group,19 cases in upper ureter,7 cases in the middle ureter and 24 cases in the lower ureter;in the control group,12 cases in the upper ureter,3 cases in the middle ureter,and 35 in the lower ureter),left and right distribution of stones [21 (right) / 29 (left) and 22 (right) / 28 (left)],long diameter of stones [(5.2 ± 0.9) mm and (5.1 ± 1.1) mm],VAS scores before treatment (7.5 ± 1.4 and 7.6 ± 1.5),and readmission rate [22 ％ (11/50) With 18％ (9/50)],1 week stone removal rate [70％ (35/ 50) and 64％ (32/50)].The incidence of adverse reactions was 8％ (4/50) in the observation group including 3 cases of nausea,1 case of vomiting.The incidence of adverse reactions was 4％ in the control group (2/50),which 2 cases showed nausea.The number of patients who chose EPVL,ESWL or surgery for the subsequent treatment in observation group was 35 cases,9 cases,and 6 cases respectively.The number of patients who chose EPVL,ESWL or surgery for the subsequent treatment in the control group was 35 cases,10 cases and 5 cases respectively.There was no significant difference between the two groups (P ＞0.05).The VAS score after treatment of the observation group was lower than that of the control group (2.4 ± 1.3 and 3.7 ± 1.5,P ＜0.01).The total effective rate of the observation group was higher than that of the control group [94％ (47/50) and 76％ (38/50),P ＜ 0.01].46 patients underwent urinary ultrasonography to check the degree of hydronephrosis.The reduction rate of hydronephrosis was higher in the observation group than in the control group [54.5％ (18/33) and 30.8％ (4/13)],but there was no significant difference between the two groups (P =0.146).In the upper ureteral calculi,the VAS score of the observation group was lower than that of the control group (2.4 ± 0.3 and 3.9 ± 0.4,P ＜ 0.01).There was no significant difference in the total effective rate between the two groups.In the lower ureteral calculi,the observation group had low VAS score after treatment.In the control group (2.4 ±0.2 and 3.5 ±0.2,P＜0.01),there was no significant difference in the total effective rate between the two groups;the middle segment stones were less included (l0 in total) and were not discussed.Conclusions The external physical vibration lithecbole adopts " head high and low position" has better effect than "head low foot high position" in treatment of ureteral calculi with renal colic,and security is acceptable.

External physical vibration lithecbole in treatment of ureteral calculi with renal colic used different positions: a prospective multicenter randomized controlled clinical study / 中华泌尿外科杂志

Objective@#To evaluate the efficacy and safety of different positions external physical vibration lithecbole (EPVL) therapy for ureteral calculi related renal colic.@*Methods@#This study was a prospective multicenter randomized controlled trial. The inclusion criteria was that patients volunteered to participate in the trial and signed informed consent, patients’age ranged from 18-65 years old, ureteral calculi related with renal colic, stone diameter was less than 7 mm, patients were not treated with analgesia, antispasmodic drugs. The exclusion criteria was that combination of severe urinary tract infection, severe hydronephrosis, urinary malformation, severe hypertension, history of cerebrovascular disease, vital organ dysfunction, obesity (BMI>35 kg/m2), history of ureteral calculi exceeded 2 months, abnormal blood coagulation. Patients were randomized into observation group and control group using random number table method. The observation group and the control group were placed on the physical vibration stone arranging machine with head low foot high position and head high foot low position respectively. The inclination angle was 24°. The secondary vibrator vibrated for 6 minutes, then the patient took the prone position and opened the main, the secondary vibrator. The treatment is completed after 6 minutes of vibration. The analgesic effect, stone removal, follow-up effects and adverse reactions in the two groups was compared. We defined the pain relief rate as(VAS score before treatment-VAS score after treatment)/VAS score before treatment×100%.@*Results@#A total of 100 patients were included in the study, 50 in the observation group and 50 in the control group. There were no statistical difference in the age of the two groups [(41.8±11.7)years and (46.6±13.9 years)], gender distribution [37(male)/13(female) and 42(male)/ 8(female)], location of stones (in the observation group, 19 cases in upper ureter, 7 cases in the middle ureter and 24 cases in the lower ureter; in the control group, 12 cases in the upper ureter, 3 cases in the middle ureter, and 35 in the lower ureter), left and right distribution of stones [21(right)/ 29 (left) and 22 (right)/ 28(left)], long diameter of stones [(5.2±0.9)mm and(5.1±1.1)mm], VAS scores before treatment (7.5±1.4 and 7.6±1.5), and readmission rate [22%(11/50)With 18%(9/50)], 1 week stone removal rate [70%(35/50) and 64%(32/50)]. The incidence of adverse reactions was 8%(4/50) in the observation group including 3 cases of nausea, 1 case of vomiting. The incidence of adverse reactions was 4% in the control group (2/50), which 2 cases showed nausea. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in observation group was 35 cases, 9 cases, and 6 cases respectively. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in the control group was 35 cases, 10 cases and 5 cases respectively. There was no significant difference between the two groups (P>0.05). The VAS score after treatment of the observation group was lower than that of the control group (2.4±1.3 and 3.7±1.5, P<0.01). The total effective rate of the observation group was higher than that of the control group [94%(47/50) and 76%(38/50), P<0.01]. 46 patients underwent urinary ultrasonography to check the degree of hydronephrosis. The reduction rate of hydronephrosis was higher in the observation group than in the control group [54.5%(18/33) and 30.8%(4/13)], but there was no significant difference between the two groups (P=0.146). In the upper ureteral calculi, the VAS score of the observation group was lower than that of the control group (2.4±0.3 and 3.9±0.4, P<0.01). There was no significant difference in the total effective rate between the two groups. In the lower ureteral calculi, the observation group had low VAS score after treatment. In the control group (2.4±0.2 and 3.5±0.2, P<0.01), there was no significant difference in the total effective rate between the two groups; the middle segment stones were less included (10 in total) and were not discussed.@*Conclusions@#The external physical vibration lithecbole adopts " head high and low position" has better effect than "head low foot high position" in treatment of ureteral calculi with renal colic, and security is acceptable.

Management of Renal Colic during Pregnancy

To determine an optimal medical and invasive intervention for renal colic patients during pregnancy. Amongthe available interventions, we investigated the reliability of a medical and inavasive interventions duringpregnancy. Between Nov 2015 and Nov 2016, a total of 200 pregnant patients came to the obstetrics andgynaecology opd, and 15 of these patients had renal colic that were referred to urological opd. The meanpatient age was 30.49 years. In this retrospective cohort study, the charts of the patients were reviewed tocollect data that included age, symptoms, the lateralities and locations of urolithiasis, trimester, pain followingtreatment and pregnancy complications. Based on ultrasonography diagnosis, 15 patients had urolithiasis,all had ureteric calculi with one having hydronephrosis and pyonephrosis and other one patient havingsevere hydronephrosis, pyonephrosis and sepsis. Conservative treatment was successful in 13 patients.Five patients were in the first trimester and ten patients in the second trimester. Out of the five patients inthe first trimester four were managed conservatively using antibiotics, hydrations and analgesics and oneamong them had severe hydronephrosis with pyonephrosis with sepsis with upper ureteric calculi in whomconservative management failed and patient was counselled and MTP was done and following that PCNLwas done as a definitive procedure. Ten patients in the second trimester medical expulsive therapy usingTamsulosin .4mg was used and complete stone clearance was achieved in Nine patients and one didn'tresponded , developed severe hydronephrosis and pyonephrosis in whom USG guided PCN was placedfor rest of the gestational period and after delivery patient underwent PCNL and complete stone clearancewas achieved. Only one patient required urological intervention that is PCN insertion. Renal colic due tocalculus during pregnancy can be effectively managed by conservative measures using hydration,antibiotics,analgesics and tamsulosin .4mg in most of the instances. Cases who do not respond to the conservativemeasure or who develops severe hydronephrosis, pyonephrosis PCN insertion and Ureteral stent insertioncan be done and patient in who develops life threatening sepsis MTP should be done followed by definitivetreatment that is PCNL.

Clinical study of Xiere-Zhuyu-Paishi decoction and auxiliary lithotripsy for the patients withupper ureteral calculi on the effect of stone removal and renal colic relief / 国际中医中药杂志

Objective To observe the effect of stone removal and relieving renal colic with Xiere-Zhuyu-Paishi decoction and auxiliary lithotripsy in patients with upper ureteral calculi. Methods A total of 80 patients with upper ureteral calculi were divided into the observation group and the control group according to the random number table method, with 40 in each group. Both groups were treated with extracorporeal shock wave lithotripsy (ESWL) as the basic treatment. Besides, the control group added the western medicine, such as pain relieving, spasmodic and anti-infection while, the observation group with Xiere-Zhuyu-Paishi decoction. Both groups were treated for 4 weeks. After 1 courses of treatment, the curative effect was evaluated. The effect of lithotripsy (lithotripsy success rate, stone clearance rate, stone expulsion time), renal colic improvement (renal colic rate, analgesic drug usage rate, pain visual analogue VAS score) and WHOQOL-BREF scores were compared. Results After treatment, the total efficiency of observation group was 92.5％ (37/40), while the control group was 75％ (25/40), and the difference was statistically significant (Z=-3.082, P=0.004). After treatment, the observation group stone clearance rate was 92％ (36/40), while the control group was 72.5％ (29/40), and the difference was statistically significant (χ2=3.986, P=0.031). After treatment, the incidence of renal colic of the observation group was 12.5％ (5/40), while the control group was 32.5％ (13/40), and the difference was statistically significant (χ2=3.146, P=0.037). The analgesic drug usage rate in the observation group was 5％ (2/40), while the the control group was 25％ (10/40), and the difference was statistically significant (χ2=4.021, P=0.019). After treatment, the observation group lithecbole time, pain VAS score levels in the observation group was significantly lower than those in the control group (t=6.261,5.743, all Ps<0.01). After treatment, the WHOQL-BREF score, the physiological domain score, psychological field score, social relationship domain score, environment the field score in the observation group were significantly higher than those of control group (t values were 6.731, 4.342, 5.064, 4.521, 5.128, all Ps<0.01).Conclusions The application of Xiere-Zhuyu-Paishi decoction and auxiliary lithotripsy in patients with upper ureteral calculi can promote stone removal in upper ureteral stones, alleviate renal colic and improve the quality of life of the patients.

Simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy

ABSTRACT Objective: To assess the safety, feasibility, and efficacy of simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy in selected patients. Patients and Methods: We retrospectively reviewed 11 consecutive cases of parapelvic renal cysts with concomitant calculi treated by flexible ureterorenoscopy and laser lithotripsy (FURSL). Marsupialization was performed subsequently with holmium: YAG laser in our institution. Fragmentation was used to manage renal stones and a novel four-step cyst localization strategy was applied in each case for marsupialization. Results: There were no intraoperative complications. Two cases of cystitis were reported postoperatively. The mean operative times of FURSL and marsupialization were 23.6 ± 3.9 minutes and 29.1 ± 9.7 minutes, respectively. During marsupialization, seven patients underwent the first two steps of the new strategy, two patients underwent three steps and two patients underwent all four steps. The mean reduction in hemoglobin level was 4.7 ± 1.7 g / L (range 3-8 g / L). The mean length of hospital stay was 1.2 ± 0.4 days. During a mean follow-up duration of 18 months, all cases remained stone-free and there was no stone recurrence. Parapelvic cysts became undetectable in eight cases and decreased in size by at least half in three cases. Conclusion: With appropriate patient selection, FURSL and marsupialization with a four-step cyst localization strategy is feasible, safe, and effective in treating parapelvic renal cysts with concomitant calculi.

Low-Dose Unenhanced Computed Tomography with Iterative Reconstruction for Diagnosis of Ureter Stones

PURPOSE: To study the clinical application of low-dose unenhanced computed tomography with iterative reconstruction technique (LDCT-IR) on renal colic in the emergency department. MATERIALS AND METHODS: We conducted a prospective, single-blinded, randomized, and non-inferiority study. From March 2014 to August 2015, 112 patients with renal colic were included, and were randomized to either LDCT-IR (n=46) or standard-dose unenhanced CT (SDCT) (n=66) groups. The accuracy of urolithiasis diagnosis was the primary endpoint of this study. Radiation dose, size and location of the stone, hydronephrosis, other diseases except urolithiasis, and results of treatment were analyzed between the two groups. RESULTS: The average effective dose radiation of SDCT was approximately four times higher than that of LDCT-IR (6.52 mSv vs. 1.63 mSv, p < 0.001). There was no significant difference in the accuracy of ureteral stone diagnosis between the two groups (LDCT-IR group: 96.97% vs. SDCT group: 98.96%, p=0.392). No significant difference was observed regarding the size and location of a stone, hydronephrosis, and diagnosis of other diseases, except urolithiasis. False negative results were found in two LDCT-IR patients and in one SDCT patient. In these patients, stones were misread as vascular calcification, and were difficult to diagnose because evidence of hydronephrosis and ureteral dilatation was not found. CONCLUSION: LDCT-IR, as a first-line imaging test, was non-inferior to SDCT with respect to diagnosis of ureter stones, and was clinically available for the evaluation of renal colic.

Current practice of antibiotic utilization for renal colic in the emergency room

ABSTRACT Introduction Urinalysis (UA) in the emergency setting for patients with nephrolithiasis produces potentially confusing results leading to treatment of presumed urinary tract infections (UTIs). Our objective was to evaluate the use of antibiotics in patients with nephrolithiasis in a large network of emergency departments (EDs). Methods A retrospective analysis of all ED visits associated with an ICD-9 diagnosis of nephrolithiasis and a CT scan between 2010 and 2013 was performed. Urinalysis data, the use of IV and PO antibiotics during the ED visit and at discharge were assessed. The presence of fever, elevated serum WBCs, >5 WBCs per hpf, and/or dip positive nitrites were used as appropriate criteria for antibiotic use. Results Urinalysis data were available for 3,518 (70%) of 5,035 patients with an ED diagnosis of nephrolithiasis and CT imaging. Of these visits, 237 patients had positive nitrites (6.7%) and 864 had >5 WBCs per hpf (24.6%) with 158 (4.5%) having both findings for a total of 943 patients. Intravenous antibiotics were given to 244 patients (25.9%) and oral antibiotics were given to 629 patients (66.7 %) with positive UA findings. Of the 2,440 patients with a negative UA and no leukocytosis or fever, 86 patients (3.5%) received IV antibiotics and 533 patients (21.8%) received PO antibiotics upon discharge. Conclusions Proper treatment of nephrolithiasis in the ED includes the screening and diagnosis of concomitant UTIs. However, correct interpretation of UA studies is vital to the correct implementation of antibiotic therapy. This study suggests that 1/3 of patients were undertreated and 21.8% were over-treated.

Therapeutic Observation of Abdominal Acupuncture plus Chinese Medication for Ureteral Calculus / 上海针灸杂志

Objective To observe the clinical efficacy of abdominal acupuncture plus Chinese medication in treating ureteral calculus. MethodA total of 106 patients with ureteral calculus were randomized into an abdominal acupuncture group (53 cases) and a medication group (53 cases). The abdominal acupuncture group was intervened by abdominal acupuncture plus medication, with Shuifen (CV9), Xiawan (CV10), Jianli (CV11), Zhongji (CV3), Guanyuan (CV4) and Qihai (CV6) selected as the major points. The removal of stones and the release of pain were observed in the two groups, and the efficacies were compared between the two groups.Result The two treatment methods both effectively improved the pain and promoted the removal of stones; the Visual Analogue Scale (VAS) scores were significantly changed after the intervention in both groups (P<0.05). The time taken to mitigate and release pain was significantly shorter in the abdominal acupuncture group compared to the other group (P<0.01). The total effective rate was 88.7% (47/53) in the abdominal acupuncture group, superior to 73.6% (39/53) in the medication group (P<0.05).ConclusionAbdominal acupuncture plus medication can effectively mitigate pain, promote the removal of stones and reduce patient's sufferings in treating ureteral calculus.

Effect of lithagogue decoction combined with tamsulosin on calculus removal rate and renal colic in patients with lower ureter calculus / 中国生化药物杂志

Objective Analyzed from row stone soup combined tan solo symplectic auxiliary row stone calculi in patients with ureteral Duan Jieshi under net rate and the influence of renal colic, so as to provide the basis for clinical treatment.Methods 90 patients with ureteral Duan Jieshi under in our hospital from January 2014 to February 2016 were selected, urology clinic of according to random, the principle of equal distribution is divided into group A (from row stone soup combined tan solo symplectic group) and group B (pure tan solo symplectic group), group C (pure traditional Chinese medicine medicinal broth group), 30 cases in each group.Observe and record the bladder irritation, frequent urination urgency), ureteral colic, discharge time, stones row net rate and incidence of adverse reactions after the comparison.Results In group A discharge time and stones row net both significantly better than B and C groups, the difference was statistically significant (P<0.05); the discharge time and stones row net between group B and C was no statistically significant difference.Group C on frequent urination urgency and ureteral colic happens to have more of A and B groups, the difference was statistically significant ( P <0.05 ); there was no statistically significant difference between group A and B.Adverse reaction of three groups of appeared in the process of treatment: group A in one case of mild diarrhea and one case of mild dizziness , group B in one case of mild headache and one case of mild dizziness, group C not present any adverse reaction, there were no significant differences in the incidence of adverse reactions among the three groups.Conclusion From row stone soup with tan solo symplectic auxiliary platoon stone therapy has good effect for patients with ureteral Duan Jieshi under, can give full play to the acetanilide spasmolysis effect of western medicine, also can better exert TCM row Shi Tong drench, analgesic anti-inflammatory, clear the role of the hot and humid, can improve the stone free rate, relieve patients with renal colic.

Factors affecting the urologist’s decision to administer ureteral stone therapy: a retrospective cohort study

OBJECTIVE: We aimed to evaluate the factors influencing treatment option selection among urologists for patients with ureteral stones, according to the stone diameter and location. METHODS: We retrospectively reviewed the records of 360 consecutive patients who, between January 2009 and June 2014, presented to the emergency department with renal colic and were eventually diagnosed with urinary stones via computed tomography. The maximal horizontal and longitudinal diameter and location of the stones were investigated. We compared parameters between patients who received urological intervention (group 1) and those who received medical treatment (group 2). RESULTS: Among the 360 patients, 179 (49.7%) had stones in the upper ureter and 181 (50.3%) had stones in the lower ureter. Urologic intervention was frequently performed in cases of upper ureteral stones (P<0.001). In groups 1 and 2, the stone horizontal diameters were 5.5 mm (4.8 to 6.8 mm) and 4.0 mm (3.0 to 4.6 mm), stone longitudinal diameters were 7.5 mm (6.0 to 9.5 mm) and 4.4 mm (3.0 to 5.5 mm), and ureter diameters were 6.4 mm (5.0 to 8.0 mm) and 4.7 mm (4.0 to 5.3 mm), respectively (P<0.001). The cut-off values for the horizontal and longitudinal stone diameters in the upper ureter were 4.45 and 6.25 mm, respectively (sensitivity 81.3%, specificity 91.4%); those of the lower ureter were 4.75 and 5.25 mm, respectively (sensitivity 79.4%, specificity 79.4%). CONCLUSION: The probability of a urologic intervention was higher for patients with upper ureteral stones and those with stone diameters exceeding 5 mm horizontally and 6 mm longitudinally.

Therapeutic Observation of Abdominal Acupuncture plus Chinese Medication for Ureteral Calculus / 上海针灸杂志

Objective To observe the clinical efficacy of abdominal acupuncture plus Chinese medication in treating ureteral calculus. MethodA total of 106 patients with ureteral calculus were randomized into an abdominal acupuncture group (53 cases) and a medication group (53 cases). The abdominal acupuncture group was intervened by abdominal acupuncture plus medication, with Shuifen (CV9), Xiawan (CV10), Jianli (CV11), Zhongji (CV3), Guanyuan (CV4) and Qihai (CV6) selected as the major points. The removal of stones and the release of pain were observed in the two groups, and the efficacies were compared between the two groups.Result The two treatment methods both effectively improved the pain and promoted the removal of stones; the Visual Analogue Scale (VAS) scores were significantly changed after the intervention in both groups (P<0.05). The time taken to mitigate and release pain was significantly shorter in the abdominal acupuncture group compared to the other group (P<0.01). The total effective rate was 88.7% (47/53) in the abdominal acupuncture group, superior to 73.6% (39/53) in the medication group (P<0.05).ConclusionAbdominal acupuncture plus medication can effectively mitigate pain, promote the removal of stones and reduce patient's sufferings in treating ureteral calculus.

Impact of parecoxib on hospital discharge: retrospective analysis of Brazilian health insurance / Impacto de parecoxibe na desospitalização: análise retrospectiva da saúde suplementar no Brasil

ABSTRACT BACKGROUND AND OBJECTIVES: Adequate postoperative pain and renal colic control is critical for patients' recovery and to decrease hospitalization costs and the use of resources. So, this study aimed at evaluating hospitalization time of patients treated with parecoxib sodium versus other non-steroid anti-inflammatory drugs to manage postoperative pain of appendectomy or fractures and renal colic. METHODS: This is a retrospective data analysis of Brazilian private hospitals medical bills, including patients treated with non-steroid anti-inflammatory drugs to decrease post-appendectomy pain (n=1618), post orthopedic fracture pain (n=2858 and renal colic (n=6555), between January and June 2014. Mean hospitalization time was evaluated according to each group of drugs. Mean difference among groups was calculated by the Kruskal-Wallis method. RESULTS: Mean hospitalization time for patients submitted to appendectomy was 1.95 days with parecoxib versus 2.20 with other non-steroid anti-inflammatory drugs (p= 0.006). For patients submitted to orthopedic fracture surgery, mean time was 1.75 days with parecoxib versus 1.93 days with other anti-inflammatory drugs (p=0.008). Parecoxib has also significantly decreased hospitalization time for renal colic as compared to other drugs (25.2h versus 32.9h; p<0.001). CONCLUSION: Parecoxib sodium has provided shorter hospitalization time with possible decrease in use of resources and costs and should be considered a choice for such painful conditions.

RESUMO JUSTIFICATIVA E OBJETIVOS: O controle adequado da dor pós-operatória e cólica renal é fundamental para a recuperação do paciente e redução de custos relacionados à hospitalização e utilização de recursos. Assim, o objetivo deste estudo foi avaliar o tempo de hospitalização entre pacientes tratados com parecoxibe sódico versus outros fármacos anti-inflamatórios não esteroides, no manuseio da dor pós-operatória associada à apendicectomia ou fraturas e cólica renal. MÉTODOS: Uma análise retrospectiva de dados de contas médicas de hospitais privados no Brasil foi realizada, incluindo pacientes tratados com anti-inflamatório não esteroide para redução da dor pós-apendicectomia (n=1.618), dor pós-fratura ortopédica (n=2.858) e cólica renal (n=6.555), entre janeiro e junho de 2014. O período médio de internação foi avaliado de acordo com cada grupo de fármacos. A diferença média entre os grupos foi avaliada utilizando o método de Kruskal-Wallis. RESULTADOS: O tempo médio de permanência hospitalar para pacientes submetidos à apendicectomia foi de 1,95 dias com parecoxibe versus 2,20 com outros anti-inflamatórios não esteroides (p = 0,006). Para pacientes submetidos a cirurgias de fraturas ortopédicas, o tempo médio foi de 1,75 dias com parecoxibe versus 1,93 dias para outros anti-inflamatórios (p=0,008). Parecoxibe também apresentou redução significativa no tempo de internação hospitalar para cólica renal em comparação com outros fármacos (25,2h versus 32,9h; p<0,001). CONCLUSÃO: Parecoxibe sódico demonstrou menor tempo de permanência hospitalar com possível redução na utilização de recursos e custos, devendo ser considerado como uma escolha para estas condições dolorosas.

Ureteral Stent Insertion in the Management of Renal Colic during Pregnancy / 전남의대학술지

To determine an optimal invasive intervention for renal colic patients during pregnancy after conservative treatments have been found to be unhelpful. Among the available invasive interventions, we investigated the reliability of a ureteral stent insertion, which is considered the least invasive intervention during pregnancy. Between June 2006 and February 2015, a total of 826 pregnant patients came to the emergency room or urology outpatient department, and 39 of these patients had renal colic. The mean patient age was 30.49 years. In this retrospective cohort study, the charts of the patients were reviewed to collect data that included age, symptoms, the lateralities and locations of urolithiasis, trimester, pain following treatment and pregnancy complications. Based on ultrasonography diagnoses, 13 patients had urolithiasis, and 13 patients had hydronephrosis without definite echogenicity of the ureteral calculi. Conservative treatments were successful in 25 patients. Among these treatments, antibiotics were used in 15 patients, and the remaining patients received only hydration and analgesics without antibiotics. Several urological interventions were required in 14 patients. The most common intervention was ureteral stent insertion, which was performed in 13 patients to treat hydronephrosis or urolithiasis. The patients' pain was relieved following these interventions. Only one patient received percutaneous nephrostomy due to pyonephrosis. No pregnancy complications were noted. Ureteral stent insertion is regarded as a reliable and stable first-line urological intervention for pregnant patients with renal colic following conservative treatments. Ureteral stent insertion has been found to be equally effective and safe as percutaneous nephrostomy, which is associated with complications that include bleeding and dislocation, and the inconvenience of using external drainage system.

Ureteral Stent Insertion in the Management of Renal Colic during Pregnancy / 전남의대학술지

To determine an optimal invasive intervention for renal colic patients during pregnancy after conservative treatments have been found to be unhelpful. Among the available invasive interventions, we investigated the reliability of a ureteral stent insertion, which is considered the least invasive intervention during pregnancy. Between June 2006 and February 2015, a total of 826 pregnant patients came to the emergency room or urology outpatient department, and 39 of these patients had renal colic. The mean patient age was 30.49 years. In this retrospective cohort study, the charts of the patients were reviewed to collect data that included age, symptoms, the lateralities and locations of urolithiasis, trimester, pain following treatment and pregnancy complications. Based on ultrasonography diagnoses, 13 patients had urolithiasis, and 13 patients had hydronephrosis without definite echogenicity of the ureteral calculi. Conservative treatments were successful in 25 patients. Among these treatments, antibiotics were used in 15 patients, and the remaining patients received only hydration and analgesics without antibiotics. Several urological interventions were required in 14 patients. The most common intervention was ureteral stent insertion, which was performed in 13 patients to treat hydronephrosis or urolithiasis. The patients' pain was relieved following these interventions. Only one patient received percutaneous nephrostomy due to pyonephrosis. No pregnancy complications were noted. Ureteral stent insertion is regarded as a reliable and stable first-line urological intervention for pregnant patients with renal colic following conservative treatments. Ureteral stent insertion has been found to be equally effective and safe as percutaneous nephrostomy, which is associated with complications that include bleeding and dislocation, and the inconvenience of using external drainage system.

Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones / Litotripsia extracorpórea no tratamento de cálculos renais e ureterais

The use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL). The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed® database between January 1984 and October 2013 using "shock wave lithotripsy" and "stone" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established.

A utilização de certos princípios técnicos e a seleção de casos favoráveis podem otimizar os resultados da litotripsia extracorpórea por ondas de choques (LECO). O objetivo deste trabalho é revisar os princípios de funcionamento da LECO, suas indicações e contraindicações, fatores preditivos de sucesso e suas complicações. Realizou-se uma pesquisa na base de dados do Pubmed® entre janeiro/1984 e outubro/2013 utilizando como palavras chaves shock wave lithotripsy e stone. Apenas artigos com bom nível de evidência, de língua inglesa, em seres humanos, do tipo clinical trials ou de revisão/metanálise foram incluídos. Na busca pela otimização dos resultados da LECO, diversos fatores técnicos, como o tipo de aparelho de litotripsia, energia e frequência dos pulsos, acoplamento do paciente ao litotridor, localização do cálculo e tipo de anestesia, devem ser levados em consideração. Fatores relacionados ao doente e ao cálculo, como seu tamanho, densidade, distância pele-cálculo, anatomia da via excretora e anomalias renais, também são importantes. A profilaxia com antibiótico não é necessária, e a passagem de duplo J de rotina não é recomendada. A prescrição de alfabloqueadores, particularmente a tansulosina, é benéfica em cálculos > 10 mm. Complicações menores podem ocorrer após LECO e geralmente respondem bem a condutas clínicas. A relação entre LECO e o surgimento de hipertensão e diabetes não está comprovada.

Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic

PURPOSE: To evaluate the distribution of ureteral stones and to determine their characteristics and expulsion rate based on their location. MATERIALS AND METHODS: We retrospectively reviewed computed tomography (CT) findings of 246 patients who visited our Emergency Department (ED) for renal colic caused by unilateral ureteral stones between January 2013 and April 2014. Histograms were constructed to plot the distribution of stones based on initial CT findings. Data from 144 of the 246 patients who underwent medical expulsive therapy (MET) for 2 weeks were analyzed to evaluate the factors responsible for the stone distribution and expulsion. RESULTS: The upper ureter and ureterovesical junction (UVJ) were 2 peak locations at which stones initially lodged. Stones lodged at the upper ureter and ureteropelvic junction (group A) had a larger longitudinal diameter (4.21 mm vs. 3.56 mm, p=0.004) compared to those lodged at the lower ureter and UVJ (group B). The expulsion rate was 75.6% and 94.9% in groups A and B, respectively. There was no significant difference in the time interval from initiation of renal colic to arrival at the ED between groups A and B (p=0.422). Stone diameter was a significant predictor of MET failure (odds ratio [OR], 1.795; p=0.005) but the initial stone location was not (OR, 0.299; p=0.082). CONCLUSIONS: The upper ureter and UVJ are 2 peak sites at which stones lodge. For stone size 10 mm or less, initial stone lodge site is not a significant predictor of MET failure in patients who have no previous history of active stone treatment in the ureter.

Value of color doppler ultrasound, kub and urinalysis in diagnosis of renal colic due to ureteral stones

Purpose Despite the routine use of helical CT in diagnosis of renal colic, there are recent concerns regarding the radiation exposure, overuse and costs. We attempted in this retrospective study to evaluate the accuracy of ultrasound (gray-scale and color Doppler with twinkling), KUB and urinalysis in diagnosis of renal colic due to ureteral calculi presented in Emergency Room. Materials and Methods A total of 939 consecutive cases of renal colic presented to ER have been managed and evaluated by ureteral ultrasound, KUB and urinalysis for the presence of ureteral stones. Non-confirmatory cases were subjected to Helical CT examination. Results Renal and ureteral ultrasound (gray-scale) alone detected ureteral calculi in 615 cases (65.4%) and after utilizing Color Doppler Ultrasound with twinkling the diagnosis was made with confidence in 935 cases (99.6%) but 4 (0.4%). KUB showed radiopaque stones in 503 (53.6%) patients and no stones were detected in 436 (46.4%). Microhematuria presented in 835 (88.9%) cases while absent in 102 (10.9%). There were 190 (20.3%), 77 (8.2%) and 671 (71.5%) patients with upper, middle and lower ureteral stones respectively. The simultaneous positive findings in US and KUB with microhematuria were found only in 453 (48.2%) cases. Conclusions The use of Color Doppler ultrasound with twinkling increased the detection rate of ureteral stones in acute renal colic patients presented to ER with less radiation exposure. Ultrasound examination as a single modality is superior to KUB and urinalysis in initial diagnosis of renal colic. .