Giant left ureteric stone.

A 24 year old male presented with acute pain in left loin with burning micturition, investigation revealed minimal functioning of left kidney with left hydronephrosis and hydroureter and a giant ureteric calculus. He underwent open ureterolithotomy. A giant ureteric calculus measuring 10.5 cm and weighing 49 gm was retrieved from the left ureter post-operative recovery was eventful and was discharged after 10 days.

Efficacy of Laparoscopic Ureterolithotomy for the Upper Ureter Stone / 대한비뇨기과학회지

PURPOSE: Ureter stones are the most common urological disease. The principal objective of this study was to evaluate the results, efficacy, and safety rates of laparoscopic ureterolithotomy for the treatment of large, upper ureteral stones. MATERIALS AND METHODS: Between April 2006 and February 2008, we conducted laparoscopic ureterolithotomy in 7 patients with upper ureter stones(L2-3). Laparoscopic ureterolithotomy was conducted in 5 patients as a salvage procedure after failed shock wave lithotripsy, in 1 patient as the primary procedure for a large stone(28mm), and in 1 patient for treatment of a radiolucent matrix stone. Laparoscopic ureterolithotomy was conducted via a transperitoneal approach. The mean stone size was 20.7+/-5.9mm. RESULTS: Laparoscopic ureterolithotomy was successful in 7 patients, and none of the patients required an open procedure. All patients were rendered stone-free after a single procedure. The mean operative duration, mean postoperative hospital stay, and mean estimated blood loss were 142+/-49 min, 6+/-2.2 days and 85+/-29.5ml, respectively. CONCLUSIONS: Although the majority of patients with ureter stones can be rendered stone-free via shock wave lithotripsy and endourological procedures, open surgery is required for large and upper ureter stones. In cases of large and upper ureter stones, laparoscopic ureterolithotomy may be considered for a limited group, although many will require open surgery.

Treatment of Upper and Mid Ureter Stones: Comparison of Semirigid Ureteroscopic Lithotripsy with Holmium: YAG Laser and Shock Wave Lithotripsy / 대한비뇨기과학회지

PURPOSE: To compare the success rates, complications and cost effectiveness of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URS) using a Holmium: YAG laser to establish the more effective treatment for upper and mid ureter stones. MATERIALS AND METHODS: This retrospective study included 83 and 286 patients treated with URS and ESWL, respectively, for upper and mid ureter stones. URS was performed with a 7.5Fr semi-rigid ureterorenoscope and Holmium: YAG laser. ESWL was performed with Stonelith V.5 (PCK, Turkey). The stone sizes, success rates, postoperative complications and cost effectiveness were analyzed for each group. RESULTS: The overall success rates of the URS and ESWL were 97.6 and 82.5%, respectively. Success rates of URS were 98.4 and 95.2% when the stones were smaller and larger than 10mm, respectively. In the ESWL group, the success rates after the third session were 86.3 and 65.4% with stones smaller and larger than 10mm, respectively. The complication rates associated with URS and ESWL were 6 and 4.2%, respectively. The average cost of URS was lower than that of ESWL. CONCLISIONS: In our study, URS with Holmium: YAG laser was more efficacious than ESWL. Considering both the success rate and cost effectiveness, URS should remain the recommended first-line treatment for upper and mid ureter stones.

The Experience of Ureterorenoscopic Lithotripsy with Insertion of Ureterorenoscope between Two Safety Guide Wires Serving as an Access Port / 대한비뇨기과학회지

PURPOSE: Although ureterorenoscopic lithotripsy (URSL) is highly successful in urinary calculous disease, there are still several problems associated with the procedure, such as the difficulty in learning the procedure and the relatively high risk of ureteral injury. We performed an URSL, with the insertion of an ureterorenoscope between two safety guide wires, which served as an access port, without the need for ureteral dilatation (new URSL), and evaluated the usefulness and efficacy of this method by a comparison of our results with those of a series of conventional URSL. MATERIALS AND METHODS: Sixty-six ureteral stones (63 cases) were treated by a new URSL procedure. At the beginning of the procedure, two safety guide wires were inserted into the ureter. The ureterorenoscope was then inserted into the ureter between the safety guide wires. The outcomes were assessed, and compared to 140 cases of conventional URSL performed by the same operator. RESULTS: The overall success rate of the new URSL procedure was 98%. The mean operation time and postoperative hospital stay were 33 minutes (10-70min) and 1.4 days (1-6 day), respectively. Complications were observed in 5 cases (7.5%), and included, an ureteral perforation in 1 case, mild to moderate ureteral injury in 2, a gross hematuria in 1 (>48 hr) and flank pain in another. CONCLUSIONS: Based on our experience, the new URSL has several merits compared to the conventional procedure, such as no need for ureteral dilatation, easiness of the insertion of the ureterorenoscope into the ureter, prevention of upward migration of the stone during the procedure, and the better visual operation field. The new URSL procedure is relatively easy to perform, with few complications, and would, therefore, be an alternative to conventional URSL.

Laparoscopic Retroperitoneal Ureterolithotomy / 대한비뇨기과학회지

PURPOSE: In the era of shock wave lithotripsy (SWL) and ureteroscopy, the majority of ureter stones are successfully managed with these less invasive treatment modalities. However, open ureterolithotomy still has a role in special situations. The efficacy of a laparoscopic retroperitoneal ureterolithotomy for large impacted ureter stones indicated for open ureterolithotomy is reported. MATERIALS AND MTHODS: Between February 1998 and December 1999, laparoscopic retroperitoneal ureterolithotomy for proximal ureter stones was performed in 5 patients who required an open ureterolithotomy. The mean size of the stones was 15mm, all of which were tightly impacted in the ureteral lumen and were associated with marked hydronephrosis. RESULTS: All but the initial operation was performed successfully via the retroperitoneal approach. Open conversion was needed in the first patient because of inexperience and the lack of anatomic perception. The mean operation time and estimated blood loss was 122 minutes and < or =50ml, respectively. A transfusion was not needed in any of the patients. Postoperative pain was well controlled with 175mg of Ketoprofen. The mean postoperative length of hospital stay was 6.3 days. There were no significant intraoperative or postoperative complications. CONCLUSIONS: A laparoscopic retroperitoneal ureterolithotomy can be considered as an alternative to conventional ureterolithotomy when open surgery is indicated.

Laparoscopic Retroperitoneal Ureterolithotomy / 대한비뇨기과학회지

PURPOSE: In the era of shock wave lithotripsy (SWL) and ureteroscopy, the majority of ureter stones are successfully managed with these less invasive treatment modalities. However, open ureterolithotomy still has a role in special situations. The efficacy of a laparoscopic retroperitoneal ureterolithotomy for large impacted ureter stones indicated for open ureterolithotomy is reported. MATERIALS AND MTHODS: Between February 1998 and December 1999, laparoscopic retroperitoneal ureterolithotomy for proximal ureter stones was performed in 5 patients who required an open ureterolithotomy. The mean size of the stones was 15mm, all of which were tightly impacted in the ureteral lumen and were associated with marked hydronephrosis. RESULTS: All but the initial operation was performed successfully via the retroperitoneal approach. Open conversion was needed in the first patient because of inexperience and the lack of anatomic perception. The mean operation time and estimated blood loss was 122 minutes and < or =50ml, respectively. A transfusion was not needed in any of the patients. Postoperative pain was well controlled with 175mg of Ketoprofen. The mean postoperative length of hospital stay was 6.3 days. There were no significant intraoperative or postoperative complications. CONCLUSIONS: A laparoscopic retroperitoneal ureterolithotomy can be considered as an alternative to conventional ureterolithotomy when open surgery is indicated.

Unenhanced Spiral CT in Acute Ureteral Colic: A Replacement for Excretory Urography?

OBJECTIVE: To compare the usefulness of unenhanced spiral CT (UCT) with that of excretory urography (EU) in patients with acute flank pain. MATERIALS AND METHODS: Thirty patients presenting with acute flank pain under-went both UCT and EU. Both techniques were used to determine the presence, size, and location of urinary stone, and the presence or absence of secondary signs was also evaluated. The existence of ureteral stone was confirmed by its removal or spontaneous passage during follow-up. The absence of a stone was determined on the basis of the clinical and radiological evidence. RESULTS: Twenty-one of the 30 patients had one or more ureteral stones and nine had no stone. CT depicted 22 of 23 calculi in the 21 patients with a stone, and no calculus in all nine without a stone. The sensitivity and specificity of UCT were 96% and 100%, respectively. EU disclosed 14 calculi in the 21 patients with a stone and no calculus in eight of the nine without a stone. UCT and EU demon-strated secondary signs of ureterolithiasis in 15 and 17 patients, respectively. CONCLUSION: For the evaluation of patients with acute flank pain, UCT is an excellent modality with high sensitivity and specificity. In near future it may replace EU.

Ureteroscopic Manipulation for Ureteral Calculi: Comparison between Local and Spinal Anesthesia / 대한비뇨기과학회지

Ureteroscopic removal of urethral calculi is an established treatment nowadays and can be performed under direct vision using flexible grasping forceps, stone baskets, electrohydraulic lithotriptor with increased safety and efficacy. In this study we tried to analyse the exact role of ureteroscopic manipulation between spinal and local anesthesia. In 127 ureteroscopic stone removal procedures performed from May 1994 to December 1996, under local anesthesia (55 case) and spinal anesthesia (72 case), the success rate and complications were measured. The sucess was defined to complete removal of stone or residual stone less than 1 mm. The success rate of the ureteroscopic manipulation was 80.3% (102/127), 81.9% (59/72), 78.4% (43/55) in total, spinal and local anesthesia, respectively. The success rate of the ureteroscopic manipulation was 75% (3/4), 71.4% (5/7), 83.6% (51/61) in upper, middle and lower ureter stones, under spinal anesthesia and 64.3% (9/14), 66.7% (6/9), 87.5% (28/32) under local anesthesia. According to the size of the stone, the success rate was 89.7% (35/39), 68.2% (15/22), 81.8% (9/)1) under spinal anesthesia when it was less than 5mm, 6 to 10 mm, and larger than 10 mm, 86.7% (26/30), 68.2% (Is/22), 66.7% (2/3) under local anesthesia. Complication was found in 16.6% of cases of the spinal anesthetic procedures and it was 21.8% of those of the local anesthetic procedures. These observations showed that ureteroscopic removal of ureteral calculi, when performed without spinal anesthesia, does not increase the risk of complications or compromise the results of treatment.

In Situ ESWL with Ultrasonographic Targeting System in the Patient with Mid Ureter Stone / 대한비뇨기과학회지

ESWL has become the most widely advocated procedure for urinary calculi because of its minimal invasiveness and high effectiveness. Unfortunately, so far most urologist use push-up or push-down technique in the treatment of mid ureter stone with ESWL. Herein, we tried in situ ESWL with ultrasonographic targeting system (Lithostar ultra, Siemens Co., Germany) in 74 mid ureter stone patients. We could target the stone in 71 out of 74 patients (71/74, 95.6%) in semilateral position in the patients with upper half of mid ureter stone or in supine position in the patients with lower half of mid ureter stone The stone was successfully removed in sixty eight patients and the success rate was 9l.1% (68/ 74). The number of treatment session was 1 to 5 (mean 1.3+/-0.8) and the duration was 20-150 minutes (mean 46.4+/-19.7 minutes). Complications were gross hematuria in 5 cases(7.0%), severe colicky pain in 2 cases (2.8%). In conclusion, we think in situ ESWL with ultrasonographic targeting system is a recommendable treatment of modality in mid ureter stone patients.

The Factors on Success in Push-up of Ureteral Stone: A Review of 103 Cases / 대한비뇨기과학회지

The ancillary practice for the management of upper ureteral stones is to push the stone up the renal pelvis before extracorporeal shock wave lithotripsy(ESWL). We evaluated 103 patients with mid and upper ureteral stones for identifying the significant factors of success in push up procedure. The clinical factors of success of push up procedure may be regarded to location (upper, mid), size( 12mm>=,12mm=, 1Mo=, 1Mo 5, WBC0.05). Complications of push up were infrequent, with hematuria (30.7%), flank pain (29.7% ), and ureteral perforation (2.2% ), all of which were managed conservatively. From these data we conclude that upper ureter stones with successful clinical factors should be tried push-up into the renal pelvis before ESWL to improve the therapeutic results.

The effects of primary in situ extracorporeal shock wave lithotripsy of upper ureteral stones : Need to be push back into kidney before ESWL / 대한비뇨기과학회지

The current practice for the management of upper ureteral stones is to push the stone back into the renal pelvis before extracorporeal shock wave lithotripsy. But recent treatment modality for urinary stone is required to be less invasive and morbid. We evaluated 194 patients with upper ureter stones for the effectiveness or push-back. When in situ treatment was performed in 122 patients, the stone free rate at 3 months was 83.6% and the storage for complete fragmentation was 153.5. Push back was tried in 72 patients randomly. Out of them, 13 cases(18.6 %) were manupulated into the renal pelvis successfully and operation was required in 2 cases due to ureteral perforation. The stone free rate was 79.6% and storage for complete fragmentation was 153.7 in push back success group. There was no significant difference between two groups. We think that the primary treatment of choice for upper urinary stone is in situ ESWL. The treatment modality of push back is secondary choice in the case that was railed by primary in situ ESWL.

The effects of the non-anesthetic, non-fluoroscopic ureteroscopic removal of the lower ureter stone / 대한비뇨기과학회지

In virtue of endourologic development recently, ureteroscopic removal of stone is widely used as treatment of the stone. But there were some complicated problems, such as radiation hazard to patient and urologist, anesthesia, expensive dilator etc. The ureteroscopic removal of stone was done in 42 cases of lower ureter stone with non-anesthetic, non-fluoroscopic ureteroscopic removal of stone. The success rate was 76.5%. and there were no severe vesicoureteral reflux and ureteral stricture as delayed complication on intravenous pyelography and voiding cystourethrography. which were checked on 3 months after. But one man, failed to removal of stone. had sepsis and managed by ureterolithotomy. Other minor complications were managed successfully by conservative method. The non-anesthetic, non-fluoroscopic ureteroscopic removal of stone was the efficient initial method to manage of the lower ureter stone, which was smaller than 1cm in size.

Spontaneous passage of ureteral stone by conservative treatment / 대한비뇨기과학회지

A statistical analysis of 92 patients with ureteral stones, who had been treated by conservative treatment was undertaken to elucidate the correlation between size of calculi and the probability of spontaneous passage. The overall rate of spontaneous passage was 69.5%. Average stone size and treatment duration were 4.0, 5.0, 4.2mm and 9.4, 10, 6.3days in order of upper. mid, lower ureter. The rate of spontaneous passage according to stone size was 80% in less than 5mm. 15% in 5-6mm and 5% in 6-7mm. Therefore, when stones are smaller than 5mm in diameter, higher chances of spontaneous passage would be anticipated in 6-7days.

Ureteroscopic Removal of Ureter Stone / 대한비뇨기과학회지

Rigid ureteroscopy is now an established technique for the management of ureteral stones and the diagnostic procedure of ureteral lesions. The results of ureteroscopic stone removal were reviewed in 153 patients (1 patient ; bilateral). From October 1989 to August 1990, 163 patients underwent ureteroscopic removal of ureter stones. There were 53 female and 100 male patients between 17 and 72 years old. In all patients with ureteral stones surgical intervention was indicated for the obstruction with deteriorating kidney function, infection or severe and prolonged pain. All procedures were performed under epidural anesthesia. Stones were extracted, using grasping forceps or stone baskets with or without electrohydraulic lithotriptor (EHL) under direct visual control. Success of ureteroscopic removal was related to the location of the calculus : 98.2% in the distal, 88.2% in mid and 79.2% in the proximal ureter (overall success rate was 94.2% ). The associated number of complications was low, with most patients being treated conservatively. We conclude that ureteroscopic removal of ureteral stone under direct vision can be done safely and be the first choice of management for the ureteral calculi.

Pseudohypoparathyroidism with a Ureteral Stone: Report of a Case / 대한비뇨기과학회지

Pseudohypoparathyroidism is a rare hereditary disorder characterized by symptoms and signs of hypoparathyroidism in association with distinctive skeletal and developmental defects. The pseudohypoparathyroidism is due to deficient end organ response to the endogenous hormone. It is represented by excessive secretion of parathyroid hormone and hyperplasia of the parathyroid glands, a response to the resistance to hormone action at the target tissues, kidney and bone. We report an unusual case of Albright syndrome associated with a ureteral stone in 3.5 years old female patient.

Comparison of Transurethral Ureteroscopy and Extracorporeal Shock Wave Lithotripsy for Treatment of Distal Ureter Calculi / 대한비뇨기과학회지

Either transurethral ureteroscopy(URS) or ESWL was the primary method of intervention in patients with stones located in the ureter distal to the radiological marking of the sacroiliac joint. 185 distal ureter calculi were treated by URS and/or ESWL, and the results, morbidity and complications were compared for the efficacy and safety of each treatment modality. We report the success and morbidity rates in 112cases undergoing URS and 73cases treated with ESWL primarily. The overall success rate was comparable with both modalities, which was 89.3% in URS and 89.0% in ESWL. Patient morbidity rate as measured by length of procedure time & postoperative stay and complication was less with ESWL than with URS. In 5 cases which was failed with ESWL, all stones were removed by URS. We conclude that ESWL or URS is the successful treatment for distal ureter calculi, however, ESWL is a noninvasive, time-saving and easily applicable technique and, therefore ESWL is more effective treatment than URS. In addition, Reserving URS for the small number of distal ureteral calculi proved refractory to ESWL, the distal ureter calculi may be handled completely by a combination of these two techniques.

Clinical Experience of Upper Ureterolithotomy by Posterior Lumbotomy / 대한비뇨기과학회지

The posterior lumbotomy was a useful approached for removal of a small kidney, for bilateral nephrectomy in patients with chronic renal failure, for pyeloplasty, for pyelolithotomy when a stone was filled the pelvis and was not able to migrated, or for an upper ureterolithotomy when the stone was firmly impacted. During a 32 month interval 19 patients underwent upper ureterolithotomy through the posterior lumbotomy approach. The intraoperative course and postoperative performance were compared to the patients operated upon using the standard flank incision. Our analysis established the superiority of the posterior lumbotomy incision for all factors evaluated, especially postoperative drainage, analgesic use and postoperative hospitalization.

Clinical Study on Transurethral Manipulation for Ureteral Stones / 대한비뇨기과학회지

The cystoscopic manipulation was performed in 82 cases of lower ureteral stones, 7 cases of mid ureteral stones and 4 cases of upper ureteral stones who visited the Department of Urology, during the period of 24 months from January 1st, 1984 to December 31st, 1985. Using Dormia stone basket in 73 cases and ureteral meatomy was performed in 20 cases and the results were as follows: 1. Dormia stone basket was used in 73 cases of ureteral stone. Immediate removal was successful in 24 cases, delayed removal in 37 cases (48 hours delay), so successful removal of stone was in 61 out of 73 cases. Failure in 12 cases, spontaneous delivery of stone was noted in cases 5 about 4-20 days after the application of Dormia stone basket did not pass through the portion of calculi and spontaneous delivery of stone was made in 14 cases after meatotomy. 2. Successful removal of stone was, mostly in proportion to the size of stone. 3. In 4 cases of upper ureteral stone, successful removal after indwelling of Dormia stone basket the position of stone for 48 hours. 4. Post management complications were fever in 12 cases, flank pain and low abdominal pain in 78 cases.

A Clinical Observation on Cystoscopic Manipulation of Distal Ureteral Stone / 대한비뇨기과학회지

We had been managed on 95 cases of distal ureteral stone with cystoscopic manipulation who were admitted to the Department of Urology, Han-iI Hospital during the period of 5 years from March 1st, 1981 to February 28th, 1986 using the Dormia stone dislodger and following results were obtained. 1. Among them, 41 cases were extracted immediately on primary application of the Dormia stone dislodgers and 7 cases were delivered by indwelling method and 13 cases were delivered spontaneously after ureteral meatotomy. 2. Over-all success rate was 67.4% but the subdivided success rate according to the size of stone decreased with increasing size of stone. 3. There were no major complication, but in one case basket was entrapped in the ureter.

A Blind-Ending Bifid Ureter with Stones / 대한비뇨기과학회지

Blind-ending bifid ureter represents a rare anomaly in the development of the ureteric bud, and a case associated with stone formation is extremely rare. We report a case of blind-ending bifid ureter with stones in the blind segment with a brief review of literature.