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Objective To study the combination treatment of lfexible/lfexible sheath and rigid ureteroscopic lithotripsy (F-ul) for upper and middle ureteral stones. Methods The clinical data of patients diagnosed of upper and middle ureteral stones were collected. The treated group (110 cases):ifrstly treated with rigid ureteroscopic lithotripsy to broke and removed stones through lfexible sheath, then the lfexible ureteroscopic lithotripsy was used to broke and removed stones through lfexible sheath;The control group (110 cases):traditional operation for ureter calculi. The clinical data was compared between the two groups. Results The effective ratio of treatment group is 90.0%, which was better than that of control group (87.3%) (P>0.05). The operation time, stone processing time of treatment group were signiifcantly shorter than those of control group (P 0.05). Conclusion The method of combining flexible/flexible sheath and rigid ureteroscopic lithotripsy for upper and middle ureteral stones was better than that of traditional operation, which worth to be popularize in clincal treatment.
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OBJECTIVE:To compare the efficacy and safety of tamsulosin or nifedipine or racanisodamine in the treatment of lower ureteral calculi. METHODS:160 patients with lower ureteral calculi were randomly divided into group A(40 cases),group B(40 cases),group C(40 cases)and group D(40 cases). All patients drank plenty of water to make daily urine output more than 2 000 ml. Based on it,group A orally received 0.4 mg Tamsulosin hydrochloride sustained release capsule,once a day. Group B orally received 10 mg Nifedipine tablet,3 times a day. Group C orally received 10 mg racanisodamine tablet,3 times a day. Group D received no other drugs except for increasing drinking. The treatment course for all groups was 2 weeks. Clinical efficacy,litha-gogue time,lithagogue size,residual calculi size and the incidence of adverse reactions in all groups were observed. RESULTS:The total effective rate in group A was higher than group C,which was higher than group B and group D,the differences were sta-tistically significant(P0.05). Lithagogue size in group A was more than group C,which was more than group B and group D,the differences were statistically significant(P0.05). Residual cal-culi size in group A was less than group B,which was less than group C and group D,the differences were statistically significant (P<0.05). And there were no severe adverse reactions in all groups. CONCLUSIONS:The efficacy of tamsulosin is superior to nifedipine and racanisodamine in the treatment of lower ureteral calculi,while nifedipine and racanisodamine show similar effica-cy,with better safety.
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Objective To assess the efficacy and safety of stenting ureteral stent prior to extracorporeal shock wave lithotrip‐sy(ESWL) for non‐obstructive upper ureter and renal stone .Methods From January 2012 to October 2013 ,a total of 96 patients who met inclusion and exclusion criteria were randomly devided into two groups :a stented group (group B) with a double‐J ureter stent fixed pre‐ESWL and a non‐stented group (group A) treated with ESWL direactly .Outcomes were evaluated in 1 month and then the ureter stent was removed ,another evaluation was taken after 2 months .Results The clearance rate in group A was signifi‐cant higher than that of group B at first month(P=0 .02) ,but group B was significant higher than that of group A at the second month(P=0 .001) .The renal colic rate of group A was significant higher than that of group B(P=0 .001) ,the gross hematuria rate of group B was significant higher than that of group A(P=0 .005) .The comparison of fever ,steinstrasse ,lower urinary tract syn‐drome showed no statistical difference(P>0 .05) .Conclusion Stenting ureter stent may increase the clearance rate of ESWL by 1 session for non‐obstructive upper ureter and renal stone ,but the passage of stones mainly happen after the removing of stent .Stent‐ing can also prevent the morbidity of renal colic without increasing low urinary tract syndrome ,but can increase the morbidity of gross hematuira .
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Objective To evaluate the effect of pneumatic ureteroscopic lithotripsy(URSL) for ureteral calculi.MethodsA total of 378 cases of ureteral calculi received URSL in our hospital by using F8/9.8 Wolf rigid ureteroscope and EMS Ⅱ pneumatic lithotripter(Switzerland).Among the cases,213 had calculi at the left side,158 at the right side,and 7 at the both sides;81 had the stones in the upper ureter,146 in the middle segment,and 158 in the lower part.Results In the cases,313 patients(320 sides) were cured after the first operation with a success rate of 82.8%(313/378).The success rates for the upper,middle,and lower ureteral calculi were 60.5%(49/81),84.2%(123/146),and 93.7%(148/158),respectively.The stones were removed completed in 1 to 8 weeks after the procedure.Fifteen patients were converted to an open surgery.In 3 patients,the URSL were stopped due to failure in placing the ureteroscope.The main postoperative complications in our series included perforation of the ureter(8 cases) and fever(13).Conclusions USRL is a safe,minimally invasive,and effective treatment.It should be the first choice for middle and lower ureteral calculi.
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PURPOSE: To determine the usefulness of unenhanced helical CT in patients with suspected renal colic. MATERIALS AND METHODS: One hundred and fourteen patients with suspected ureteral colic, referred by physicians, underwent unenhanced helical CT. Two radiologists prospectively interpreted the results, determining the presence or absence of ureter stone and other diseases that arise outside the urinary tract. In cases of ureteral stone, we retrospectively sought secondary signs of hydronephrosis, perinephric fat stranding, thickening of renal fascia, renal enlargement, and the tissue rim sign. RESULTS: Among the 114 patients, 57 were confirmed as having ureter stones. Unenhanced helical CT depicted 57 of 58 stones in 57 patients, producing one false-negative and one false-positive result. Overall, the results showed 98% sensitivity, 95% specificity, 98% positive predictive value, 95% negative predictive value, and 97% accuracy. The frequencies of secondary signs were as follows: hydronephrosis, 95% (54/57); perinephric fat stranding, 81% (46/57); thickening of renal fascia, 77% (44/57); renal enlargement, 65% (37/57); and the tissue rim sign 72% (21/29). In 20 patients, the diagnoses were not related to stone disease and included one falsenegative diagnosis of pyonephrosis. CONCLUSION: Unenhanced helical CT provides information which is valuable in the accurate diagnosis of ureteral stone as well as other diseases that arise outside the urinary tract in patients with suspected renal colic.
Subject(s)
Humans , Diagnosis , Fascia , Hydronephrosis , Prospective Studies , Pyonephrosis , Renal Colic , Retrospective Studies , Sensitivity and Specificity , Tomography, Spiral Computed , Ureter , Urinary TractABSTRACT
PURPOSE: To determine, when extracorporeal shockwave lithotripsy is contraindicated, the usefulness and safety of percutaneous management in the removal from the upper urinary tract of foreign bodies and calculi, or small remnants of these, retained affer percutaneous nephrolithotomy. MATERIALS AND METHODS: Between January 1996 and May 2001, we attempted to retrieve foreign bodies or calculi from the upper urinary tract of 20 patients, using various percutaneous techniques. There were eleven foreign bodies, namely fragmented nephrostomy catheters (n=2), migrated ureteric stents inaccessible to retrograde ureteroscopic management (n=8), and one metallic radiopaque marker which was separated from the pusher of the internal ureteral stent. Nine urinary tract calculi were present. These ranged in radiographically measured size from 4 to 8 mm in their largest diameter, and were found in the renal pelvis or calyx (n=5) and ureter (n=4). After percutaneous nephrostomy, all procedures involved the use of a 7-F to 14-F sheath, inserted under fluoroscopic guidance. Devices used for the retrieval of these objects include a stone basket retriever, loop snare, grasping forceps, and balloon catheter. RESULTS: In all cases except one, it was possible to retrieve calculi or other items from the upper urinary tract. No surgical procedure was required and no significant complications were encountered in any of the cases during or after the procedures. CONCLUSION: The percutaneous technique can be useful and safe in the management of foreign bodies or calculi present in the upper urinary tract.
Subject(s)
Humans , Calculi , Catheters , Foreign Bodies , Hand Strength , Kidney Pelvis , Lithotripsy , Nephrostomy, Percutaneous , SNARE Proteins , Stents , Surgical Instruments , Ureter , Urinary TractABSTRACT
PURPOSE: Central lucency of pelvic phleboliths is frequently observed on plain pelvic radiographs. When it is also present on noncontrast helical CT images, pelvic phleboliths may be easily diagnosed, with no suspicion of distal ureteral calculi. The objective of this study was to determine the frequency with which this phenome-non is seen on plain radiographs and noncontrast helical CT images. MATERIALS AND METHODS: During a recent two-year period we identified 70 patients with renal colic who under-went both abdomino-pelvic radiography and noncontrast helical CT scanning. Radiographs were obtained at 70 -85 kVp and 30 -40 mA; CT scans were preformed within one month of plain radiography with parameters of 120 kVp, 200 -220 mA, 5-mm collimation, and pitch of 1 -1.6, and using soft tissue and bone window settings. With regared to the central lucency of pelvic phleboliths, as seen on both on radiographs and CT im-ages, two experienced radiologists reached a consensus. RESULTS: Among the 70 patients, a total of 150 pelvic phleboliths was found. In all cases except one, pelvic radi-ography and noncontrast helical CT revealed the same number of phleboliths. The exception was a case in which one of two phleboliths demonstrated by CT was not seen on radiographs. Pelvic radiography revealed central lucency in 95 of these 150 phleboliths (63%), but noncontrast helical CT failed to depict a hypodense center in any phlebolith. CONCLUSION: Central lucency of pelvic phleboliths, as frequently seen on plain pelvic radiographs, was not revealed by routine noncontrast helical CT in any patient.The presence or absence of central lucency on these CT images cannot, therefore, be used to differentiate phleboliths from distal ureteral calculi.
Subject(s)
Humans , Consensus , Radiography , Renal Colic , Tomography, Spiral Computed , Tomography, X-Ray Computed , Ureteral CalculiABSTRACT
PURPOSE: To determine the usefulness of transrectal ultrasound (TRUS) and to compare TRUS with intravenousurography (IVU) in the evaluation of distal ureteral calculi. MATERIALS AND METHODS: TRUS and IVU were perfomed in 24 patients with distal ureteral calculi. Using TRUS, we evaluated the presence and size of calculus, type of ureteral jet at the affected site and diameter of ureter proximal to calculus, and using IVU evaluated the presence and size of calculus, degree of ureteral obstruction, and degree of hydroureter. TRUS and IVU findings, were compared. RESULTS: In each patient, TRUS detected calculus of the distal ureter ; in only 18cases (75%),were the calculi demonstrated with IVU. In 18 cases where calculi were detected by both modalities, average calculus size was 4.5 X 3.0mm (longest and shortest dimensions) by IVU, and 6.1 X 3.7 mm by TRUS. Betwee TRUS and IVU(p0.05). CONCLUSION: TRUS appears to be a useful adjunctive method for the evaluation of distal ureteral calculus.