Effect of a low-calorie diet on 24-hour urinary parameters of obese adults with idiopathic calcium oxalate kidney stones

ABSTRACT Purpose: to evaluate the effect of low-calorie diet on 24-hour urinary metabolic parameters of obese adults with idiopathic calcium oxalate kidney stones. Materials and Methods: Adult idiopathic calcium oxalate stone formers, with body mass index (BMI) ≥30kg/m2 and a known lithogenic metabolic abnormality, were submitted to low-calorie diet for twelve weeks. After enrolment, anthropometric measures, serum exams, 24-hour urinary metabolic parameters and body impedance were collected one month prior to dietary intervention and at the end of twelve weeks. Correlations between weight loss, waist circumference loss, fat loss and variation in 24-hour urinary lithogenic parameters and calcium oxalate urinary supersaturation (CaOx SS) as per Tiselius equation were analysed. Results: From January 2017 to January 2018, 39 patients were enrolled to participate in this study. Median (range) prescribed diet was 1300 (1100-2100) Kcal/day. Mean age was 51.7±11.0 (29-68) years old and 69.2% were female. 30.8% of the participants shifted from obesity to BMI <30kg/m2 and none to BMI <25kg/m2. A significant correlation was found between baseline 24-hour urinary oxalate and weight (p=0.018) and BMI (p=0.026). No correlation was found between variation of weight, waist circumference, fat mass and 24-h urinary stone risk factors or CaOx SS. Conclusions: Short-term modest weight loss induced by twelve weeks of low-calorie diet is not associated with a decrease of 24-hour urinary lithogenic parameters in idiopathic calcium oxalate stone formers. Calcium oxalate urinary stone formation is probably multifactorial and driven by other factors than weight.

Análisis de la composición química de litiasis urinaria de 649 pacientes mediante espectroscopía infrarroja, primera experiencia nacional / Chemical composition analysis of 649 urinary stones

Background: Chemical composition analysis of urinary stones is a fundamental part of the metabolic workup of urolithiasis. Aim: To report the chemical composition of urinary stones using infrared spectroscopy. Material and Methods: The chemical composition of rinary stones recovered from 649 patients aged 1 to 97 years (68% males), were analyzed using a Perkin Elmer FTIR Spectrometer, Spectrum Two. Results: Calcium oxalate monohydrate was the most common composition found in 45% of cases, followed by mixed composition, which included three ammonium phosphate stones in 29% of cases. Pure uric acid composition was found in 16% of stones. Three cystine stones were detected. Conclusions: These findings do not differ from those found in developed countries.

Impact of intestinal flora on calcium oxalate stones / 中南大学学报(医学版)

Kidney stone is one of the common diseases of the urinary system. About 80% of kidney stones are mainly composed of calcium oxalate. As a huge bacterial network, the interaction of gut microbes is complex. Intestinal microbes may play a role in the pathogenesis and prevention of kidney stones. The intestinal flora of patients with calcium oxalate stones possess unique distribution of gut microbes.

Upper urinary tract stone compositions: the role of age and gender

ABSTRACT Objective: To analyze the compositions of upper urinary tract stones and investigate their distributions in different gender and age groups. Materials and Methods: Patients diagnosed with upper urinary tract stone disease between December 2014 and March 2018 were retrospectively reviewed. Patient's age, gender, BMI, comorbidities, stone event characteristics, and compositions were collected, and proportions of stone components in different gender and age groups were analyzed. Results: A total of 1532 stone analyses were performed (992 from males and 540 from females). The mean age was younger in males (p <0.001). Males included more cases with larger BMI, hyperuricemia, and obesity, while females had more urinary tract infections. Multiple components were present in 61.8% of stones. Calcium oxalate (CaOx) (67.0%) was the most common component, followed by uric acid (UA) (11.8%), infection stone (11.4%), calcium phosphate (CaP) (8.0%), cystine (1.1%), brushite (0.4%), and 2, 8-dihydroxyadenine (0.2%). Men contributed with more CaOx stones than women at age 30-49 years (all p <0.01) and more UA stones at 30-59 years (all p <0.05). Women contributed with more infection stones than men in age groups 30-49 and 60-69 years (all p <0.05), and more CaP stones at 30-49 years. The prevalence peak was 50-59 years in men and 60-69 years in women. Both genders had the lowest prevalence in adolescence. Prevalence of UA stones increased while that of infection stones decreased with aging in both genders. Conclusions: Age and sex had a strong association with distribution of stone compositions in this Chinese cohort.

Low-dose intravenous ketamine versus intravenous ketorolac in pain control in patients with acute renal colic in an emergency setting: a double-blind randomized clinical trial / 대한통증학회지

BACKGROUND: This study was conducted to compare the effectiveness of low-dose ketamine versus ketorolac in pain control in patients with acute renal colic presenting to the emergency department (ED). METHODS: This is a double-blind randomized clinical trial. The initial pain severity was assessed using the numerical rating scale (NRS). Then, ketamine or ketorolac was administered intravenously at a dose of 0.6 mg/kg and 30 mg respectively. The pain severity and adverse drug reactions were recorded 5, 15, 30, 60, and 120 min thereafter. RESULTS: The data of 62 subjects in the ketamine group and 64 patients in the ketorolac group were analyzed. The mean age of the patients was 34.2 ± 9.9 and 37.9 ± 10.6 years in the ketamine and ketorolac group, respectively. There was no significant difference in the mean NRS scores at each time point, except for the 5 min, between the two groups. Despite a marked decrease in pain severity in the ketamine group from drug administration at the 5 min, a slight increase in pain was observed from the 5 min to the 15 min. The rate of adverse drug reactions, including dizziness (P = 0.001), agitation (P = 0.002), increased systolic blood pressure (> 140 mmHg), and diastolic blood pressure (> 90 mmHg) was higher in the ketamine group. CONCLUSIONS: Low dose ketamine is as effective as ketorolac in pain management in patients with renal colic presenting to the ED. However, it is associated with a higher rate of adverse drug reactions.

A systematic review on the safety and efficacy of Blumea balsamifera (L.) DC (NIRPROMP Tablet) for the treatment of Urinary Tract Stone

Objective@#To evaluate the safety and efficacy of Blumea balsamifera (L.) DC for the treatment of urinary tract stones.@*Methods@#Data were collected from online databases, the Philippine National Library, and unpublished clinical trials. We obtained permission from authors of unpublished clinical trials but with existing patent applications. Studies were selected based on the criteria: randomized controlled trials (RCT) on the efficacy of Blumea balsamifera (L.) DC for the treatment of urinary tract stones given alone or in combination with a non-pharmacological/pharmacological intervention in comparison to a pharmacological/non-pharmacological intervention for urinary tract stones with participants aged 15 to 65 years in an ambulatory setting.@*Results@#Our search methods yielded a total of 20 studies. Four studies met our inclusion criteria. Patients who took sambong had a reduction in stone size by radiographic evidence 23.45 times more than those who took the placebo (p=0.001). Also, patients taking sambong were 38.04 times more likely to pass stones compared to those patients taking a placebo (p=0.0004). Patients taking sambong were 7.48 times more likely to have reduction or disappearance of signs and symptoms compared to the placebo group (p=0.008).@*Conclusions@#Sambong treatment is effective in treating patients with urolithiasis by radiographic evidence of a decrease in size and/or number of stones, the passage of stone/s and/or disappearance or reduction of signs and symptoms with no serious adverse events.

The impact of surgical intervention on renal function in cystinuria / O impacto da intervenção cirúrgica sobre a função renal na cistinúria

ABSTRACT Introduction: Cystinuria is an autosomal recessive disorder due to intestinal and renal transport defects in cystine and dibasic amino acids, which result in recurrent urolithiasis and surgical interventions. This study aimed to assess the impact of surgical interventions on renal function by analyzing estimated glomerular filtration rates. Methods: Thirteen pediatric patients with cystinuria, who were followed-up in a single tertiary institution between 2004 and 2016, were included in the study. Medical records were reviewed to collect data on clinical presentation of patients, urine parameters, stone formation, medical treatment, surgical intervention, stone recurrence after surgical procedure, stone analysis, ultrasonography, 99m-technetium dimercaptosuccinic acid (99mTc-DMSA) radionuclide imaging results, and follow-up time. Creatinine clearances estimated by modified Schwartz (eGFR) formula before and after surgery were used to assess renal function and compared statistically. Results: Nine patients (69.2%) had renal scarring which were detected with 99mTc-DMSA radionuclide imaging. In ten patients (76.9%), open surgical intervention for stones were needed during follow-up. Significant difference was not detected between eGFR before and after surgical intervention (mean 92 versus 106, p = 0.36). Nine of the patients (69.2%) were stone free in the last ultrasonographic examination. Relapses of stone after surgery were seen in 66.6% of patients who underwent surgical intervention. Conclusions: Surgical interventions for urinary stones are commonly required in patients with cystinuria. Renal scarring is a prevalent finding in cystinuric patients. Surgical interventions have no negative impact on eGFR in patients with cystinuria according to the present study.

RESUMO Introdução: A cistinúria é um distúrbio autossômico recessivo causado por defeitos de transporte intestinal e renal da cistina e aminoácidos dibásicos que resultam em urolitíase recorrente e necessidade de intervenção cirúrgica. O presente estudo teve por objetivo avaliar o impacto das intervenções cirúrgicas sobre a função renal por meio da análise da taxa de filtração glomerular estimada. Métodos: Treze pacientes pediátricos com cistinúria acompanhados em uma instituição terciária entre 2004 e 2016 foram incluídos no estudo. Os prontuários médicos foram analisados e utilizados como fonte de dados sobre a apresentação clínica dos pacientes, parâmetros urinários, formação de cálculos, tratamento clínico, intervenção cirúrgica, recidiva de cálculos após procedimento cirúrgico, análise de cálculos, ultrassonografia, resultados de imagens com ácido dimercaptossuccínico marcado com tecnécio metaestável (99mTc-DMSA) e tempo de seguimento. A depuração de creatinina estimada pela fórmula modificada de Schwartz (TFGe) antes e após a cirurgia foi utilizada para avaliar e comparar estatisticamente os níveis de função renal. Resultados: Nove pacientes (69,2%) apresentaram cicatrizes renais detectadas por exame de imagem com 99mTc-DMSA. Dez pacientes (76,9%) necessitaram intervenção cirúrgica aberta por cálculo renal durante o seguimento. Não foram detectadas diferenças significativas entre os valores de TFGe anteriores e posteriores à intervenção cirúrgica (média de 92 vs. 106, p = 0,36). Nove pacientes (69,2%) não apresentaram cálculos no último exame ultrassonográfico. Recidivas de cálculos renais após cirurgia foram observadas em 66,6% dos pacientes submetidos a cirurgia. Conclusões: Intervenções cirúrgicas relativas a cálculos renais são frequentemente necessárias em pacientes com cistinúria. Cicatrizes renais são um achado prevalente em pacientes com cistinúria. De acordo com o presente estudo, cirurgia não afeta negativamente a TFGe de pacientes com cistinúria.

Litiasis renal en Paraguay: herramientas laboratoriales en la identificación de etiología y seguimiento del paciente litiásico / Nephrolithiasis in Paraguay: Laboratory tools in the identification of etiology and follow-up of the lithiasic patient

La litiasis renal es una patología que se caracteriza por la formación, agregación y retención de cristales en las vías urinarias. Su etiología es compleja ya que la misma puede ser el resultado de la interacción de múltiples factores tanto endógeno, metabólico como ambiental. La elevada tasa de recurrencia de la formación de cálculos puede superar el 40% en un periodo de 5 años tras el primer episodio y puede conllevar consecuencias graves para el funcionamiento renal con su consiguiente impacto en la calidad de vida del paciente(AU)

Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion

ABSTRACT Objective To present our experience in minimally invasive management of urinary tract stones in patients with urinary diversion. Materials and Methods We retrospectively reviewed 26 patients with urinary tract stones after cystectomy and urinary diversion. The types of urinary diversion were ileal conduit, colon conduit, ileal orthotopic neobladder in 19, 4, and 3 patients, respectively. At postoperative days 2, a plain KUB and urinary ultrasonography were performed in order to assess stone fragmentation or hydronephrosis. According to postoperative imaging, stone free rate (SFR) was defined as complete absence of fragments or residual stones less than 4mm. Results 19 patients were treated with minimally invasive percutaneous lithotripsy (MPCNL) and 2 patients required second-look MPCNL. Anterograde flexible ureteroscopy was performed in 2 patients, while in 2 patients a combined anterograde and retrograde approach was required. Three reservoir stones were treated by transurethral neo-bladder lithotripsy. Postoperative significant complications occurred in 2 patients (7.7%). The highest percentage of stone composition was struvite, as a result of chronic urinary tract infection (UTI). SFR was 88.5% (23 of 26). Conclusions Our experience showed that MPCNL is a safe and effective treatment modality with little morbidity for renal and upper ureteral stones in patients with urinary diversion. For middle and lower ureteral stones, an anterograde approach could be also considered as a first line treatment, but a combined anterograde and retrograde approach was required when the anterograde access alone cannot provide acceptable results.

Types for 1 849 patients with urinary calculi and patients' clinical characteristics / 中南大学学报(医学版)

To analyze types of urinary calculi and patients' clinical characteristics, and to explore the strategies for prevention and treatment of urinary calculi.
 Methods: A total of 1 849 patients with urinary calculi were treated in the Department of Urology, the Third Xiangya Hospital of Central South University. The components were analyzed by infrared spectroscopy. The relationship between stone composition and clinical parameters was analyzed according to the clinical characteristics of the patients.
 Results: The proportion of calcium oxalate stone or uric acid stone in male (84.1% or 7.7%) was higher than that in female (78.4% or 4.2%). The older patients were more likely to be diagnosed as uric acid stone. The proportions of uric acid stone in patients <18 years old, 18-<41 years old, 41-<66 years old, and ≥66 years old were 0.0%, 1.6%, 6.6%, and 12.4%, respectively. There was no significant difference in the proportion of stones in patients with different BMI. There were no significant difference in the stone composition between the patients with or without urinary tract infection, hypertension or diabetes. The proportion of uric acid stones in patients with acidic urine was higher than the other types. The proportion of uric acid stones in patients with elevated creatinine (12.1%) was higher than that in the patients with normal creatinine (4.5%).
 Conclusion: Elderly patients, or patients with high uric acid and renal insufficiency are more prone to uric acid stones. Regulation of urinary pH may be an important strategy for preventing and treating urinary calculi in Hunan Province.

Is the Serum Uric Acid Level Independently Associated with Incidental Urolithiasis?

OBJECTIVE: Urolithiasis is one of the manifestations of gout and the risk is higher in gouty patients. On the other hand, an independent association between the urinary stone and serum uric acid (UA) level has not been established. This study examined whether the risk of urolithiasis increases with increasing serum UA level. METHODS: Among the people who visited a tertiary hospital from 2010 to 2013, 13,964 individuals who underwent both ultrasonography and a laboratory test were recruited in the study. The risk of urolithiasis on ultrasonography was analyzed in association with the serum UA level by multiple logistic regression analysis with an adjustment for age, sex, body mass index, estimated glomerular filtration rate, and known underlying diseases, including diabetes mellitus and hypertension. RESULTS: Among the 6,743 men (48.3%) and 7,221 women (51.7%), the age was 51.3±13.5 and the serum UA level was 4.5±2.1 mg/dL. Hyperuricemia (>7 mg/dL) was observed in 1,381 cases (9.9%). Urolithiasis was detected by ultrasonography in 608 cases (4.4%). The detection rates of urolithiasis in individuals with hyperuricemia and normouricemia were 5.9% and 4.1%, respectively (p=0.001). Multiple logistic regression analysis showed that individuals with hyperuricemia had a significantly higher risk of urolithiasis (adjusted odds ratio [OR]=1.54; 95% confidence interval [CI], 1.20~1.96; p=0.001). A comparison of the highest with the lowest quartile of serum UA revealed a multivariable-adjusted OR of 3.17 (95% CI, 1.98~5.11) for men and 1.79 (1.08~2.93) for women. CONCLUSION: These results suggest that individuals with a higher serum UA level have a higher risk of subclinical and clinical urolithiasis.

Ultrasonography of acute flank pain: a focus on renal stones and acute pyelonephritis

Ultrasonography is a useful tool for the differential diagnosis of acute flank pain. Renal stones appear as a focal area of echogenicity with acoustic shadowing on ultrasonography. In acute pyelonephritis (APN), the kidneys may be enlarged and have a hypoechoic parenchyma with loss of the normal corticomedullary junction. However, clinical and laboratory correlations are essential for the diagnosis of renal stones and APN through imaging studies. This review describes the typical ultrasonography features of renal stones and APN. Moreover, in daily practice, cross-sectional imaging is essential and widely used to confirm renal stones and APN and to differentiate them from other diseases causing flank pain. Other diseases causing acute flank pain are also described in this review.

Diagnosis and management of urinary tract stone in family practice

Background@#Urinary tract stones or calculi are low-density crystals in any part of the urinary tract that result from either excessive excretion or precipitation of salts in the urine or lack of substances to inhibit its formation. Prevention and management of urinary tract stones is also now medically feasible and recommended.@*Objectives@#This clinical pathway was developed to guide family and community physicians on the diagnosis and initial management of urinary tract stone in terms of: 1) clinical history and physical examination; 2) laboratory and ancillary procedures to be requested; 3) pharmacologic interventions; 4) non-pharmacologic interventions; and 5) patient outcomes to expect.@*Methods@#The PAFP Clinical Pathways Group reviewed the previous guidelines for the treatment of urinary tract stones, published medical literature (PubMed and HERDIN) to identify, summarize, and operationalize the clinical content of diagnostics, interventions and clinical indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice.@*Recommendations@#Family physicians should elicit patient history of flank pain, tenderness, dysuria and hematuria. They must be described in detail in terms of, characteristics, date of onset and severity. Other patient history to elicit should include stone passage, recurrent UTI, dietary history, fluid intake, recurrent UTI, medications and family history of being a stone former or some metabolic disorder. The laboratory should include ultrasound of kidney, ureter and bladder (plain CT is second line imaging study), urinalysis and blood chemistry (BUN, creatinine, calcium and uric acid). Symptomatic treatment with non-steroidal anti-inflammatory drugs or opioid analgesic in severe pain should be started even before the definitive diagnosis. Anti-spasmodic therapy may also be given. If stone is present, medical dissolution therapy for all stone sizes (alone or as complementary to medical expulsion, lithotripsy or surgery), medical expulsion therapy for stone size 5-10 mm and lithotripsy or surgery if greater than 10 mm. Non-pharmacologic treatment includes patient education, increased fluid intake to achieve at least 2-2.5 liters of urine per day and limit sodium intake (no evidence to limit calcium or protein intake). Family intervention to adjust family diet preference to low sodium is also recommended. @*Implementation@#To promote rational management of urinary tract stone in family practice, outreach visits to individual family physician’s clinic have been identified as an intervention that may improve the practice of health care professionals. This type of ‘face to face’ visit has been referred to educational detailing or academic detailing. Organizational activities such as quality improvement activities will also be encouraged.

Predicting model based on risk factors for urosepsis after percutaneous nephrolithotomy / 北京大学学报(医学版)

OBJECTIVE@#To analyze the potential perioperative risk factors that affect the development of urosepsis following percutaneous nephrolithotomy (PCNL) for upper urinary tract calculi with a regression model, and to develop a nomogram for predicting the probability of postoperative urosepsis after PCNL according to the identified independent risk factors.@*METHODS@#We retrospectively analyzed the clinical data from consecutive 405 cases of upper urinary tract calculi treated by one-phase PCNL between January 2013 and December 2016 in our clinical department. According to whether the patients developed urosepsis or not after the surgery, the patients were divided into two groups. Perioperative risk factors that could potentially contribute to urosepsis were compared between the two groups. By a Logistic regression model, univariate and multivariate statistical analyses were carried out for the occurrence of postoperative urosepsis, to identify the independent risk factors affecting the development of postoperative urosepsis. From this model, a nomogram was built based on regression coefficients.@*RESULTS@#The PCNL procedures of the 405 cases were performed successfully, and there were 32 cases that developed urosepsis after the PCNL, and the incidence of urosepsis was 7.9% (32/405). A multivariate Logistic regression model was built, excluding the factors with values of P>0.05 in the univariate analysis. Multivariable Logistic regression analysis identified the following factors as independent risk factors for urosepsis after PCNL: diabetes mellitus history (OR=4.511, P=0.001), larger stone burden (OR=2.588, P=0.043), longer operation time (OR=2.353, P=0.036), increased irrigation rate (OR=5.862, P<0.001), and infectious stone composition (OR=2.677, P=0.036). The nomogram based on these results was well fitted to predict a probability, and the concordance index (C-index) was 0.834 in the nomogram model sample and 0.802 in the validation sample.@*CONCLUSION@#Diabetes mellitus history, higher stone burden, longer operation time, increased intraoperative irrigation rate, and infectious stone composition are identified as independent risk factors to affect the development of urosepsis after one-phase percutaneous nephrolithotomy for upper urinary tract calculi. A nomogram based on these perioperative clinical independent risk factors for urosepsis could be used to predict the risk of urosepsis following PCNL.

Analgesia for patients undergoing shockwave lithotripsy for urinary stones – a systematic review and meta-analysis

ABSTRACT Background Shock wave lithotripsy (SWL) is the first line treatment modality for a significant proportion of patients with upper urinary tracts stones. Simple analgesics, opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are all suitable agents but the relative efficacy and tolerability of these agents is uncertain. Objectives To determine the efficacy of the different types of analgesics used for the control of pain during SWL for urinary stones. Materials and Methods We searched the Cochrane Renal Group’s Specialised Register, MEDLINE, EMBASE and also hand-searched reference lists of relevant articles (Figure-1). Randomised controlled trials (RCT’s) comparing the use of any opioid, simple analgesic or NSAID during SWL were included. These were compared with themselves, each-other or placebo. We included any route or form of administration (bolus, PCA). We excluded agents that were used for their sedative qualities. Data were extracted and assessed for quality independently by three reviewers. Meta-analyses have been performed where possible. When not possible, descriptive analyses of variables were performed. Dichotomous outcomes are reported as relative risk (RR) and measurements on continuous scales are reported as weighted mean differences (WMD) with 95% confidence intervals. Results Overall, we included 9 RCTs (539 participants from 6 countries). Trial agents included 7 types of NSAIDs, 1 simple analgesic and 4 types of opioids. There were no significant differences in clinical efficacy or tolerability between a simple analgesic (paracetamol) and an NSAID (lornoxicam). When comparing the same simple analgesic with an opioid (tramadol), both agents provided safe and effective analgesia for the purpose of SWL with no significant differences. There were no significant differences in pain scores between NSAIDs or opioids in three studies. Adequate analgesia could be achieved more often for opioids than for NSAIDs (RR 0.358; 95% CI 043 to 0.77, P=0.0002) but consumed doses of rescue analgesia were similar between NSAIDs and opioids in two studies (P=0.58, >0.05). In terms of tolerability, there is no difference in post-operative nausea and vomiting (PONV) between the groups (RR 0.72, 95% CI 0.24 to 2.17, P=0.55). One study compared outcomes between two types of NSAIDs (diclofenac versus dexketoprofen). There were no significant differences in any of our pre-defined outcomes measures. Conclusion Simple analgesics, NSAIDs and opioids can all reduce the pain associated with shock wave lithotripsy to a level where the procedure is tolerated. Whilst there are no compelling differences in safety or efficacy of simple analgesics and NSAIDs, analgesia is described as adequate more often for opioids than NSAIDs.

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.

Effect of stone composition on the outcomes of semi-rigid ureteroscopy using holmium: yttrium-aluminum-garnet laser or pneumatic lithotripsy

Objective: To compare the effectiveness of laser lithotripsy [LL] and pneumatic lithotripters [PL] in calcium oxalate [CaOx] and calcium phosphate [CaP] stones and assess whether these stone compositions affect the outcomes of LL and PL

Study Design: Comparative, descriptive study

Place and Duration of Study: Istanbul Training and Research Hospital, Turkey, from August 2010 to August 2015

Methodology: A total of 114 patients underwent ureteroscopy using LL and PL. Fifty-eight [50.9%] had CaOx stones and 56 [49.1%] had CaP stones. The lithotripters were compared in stone composition groups, and stone compositions were compared in lithotripter groups. Patient characteristics, perioperative parameters, and postoperative complications were compared

Results: The baseline patient and stone characteristics were similar in all groups. The operation time of the PL and LL for the patients with CaP stones [68.75 +/- 32.88 and 44.48 +/- 34.37 minutes, respectively] was significantly shorter than the operation time of the PL and LL for the patients with CaOx stones [91.56 +/- 30.54 and 65.75 +/- 37.74 minutes, [p=0.012 and p=0.009, respectively]. Moreover, the patients with CaOx or CaP treated with LL [65.75 +/- 37.74 and 44.48 +/- 34.37 minutes, respectively] had significant shorter operation time than the PL [91.56 +/- 30.54 and 68.75 +/- 32.88 minutes, [p=0.046 and p=0.01, respectively]. Stone-free rates were similar in all groups. The PL for the patients with CaP stones caused more postoperative fever and infection than the other groups [p=0.050]

Conclusion: Though both PL and LL are effective in the treatment of CaOx and CaP stones, LL had a significantly shorter operation and hospitalization time and complication rates in patients with CaOx and CaP stones. So LL is a more feasible and safer modality in the treatment of recurrent CaP stones