Ureteral stent versus percutaneous nephrostomy for diversion of stone-induced hydronephrosis

Urinary diversion of the obstructed hydronephrosis kidney is indicated by symptoms, such as persistent renal colic, febrile UTI [urosepsis], and uraemia. This study is an attempt to evaluate [PCN] versus ureteral stent in cases of stone-induced hydronephrosis regarding relief of symptoms and quality of life. A total of 40 patients with stone-induced hydronephrosis were randomized into either [PCN] or stent insertion groups. These patients were then evaluated regarding to [a]- the procedure [use of analgesics, x-ray exposure, success of insertion], [b]- relief of accompanying symptoms [duration of diversion, intravenous administration of antibiotics for high temperature]; and [c]- the quality of life. Two groups of patients: [a] - the group of [PCN] has an average age of 55 years, and a male-to-female ratio of 12:8. [b]- The group of ureteral stent has an average age of 49 years, and a male-to-female ratio of 9:11. - [PCN] was successfully completed in 100% of patients and stents were successful in 80%, with a 20% conversion to [secondary PCN].- The x-ray exposure was shorter in the [PCN] group [p = 0. 052].- Administration of analgesics was more frequent in the stent group [p = 0. 061]. - [PCN] indwelling time was shorter [50% less than 2 weeks] than that of stents [25% less than 2 weeks] [p = 0.043]. - Antibiotics were administered for greater than 6 days in 0% of patients who underwent [PCN] versus 70% in those with stents [p = 0.174]. - Reduction in quality of life was moderate but more pronounced in patients with stents compared to those who underwent [PCN], and was more distinct in males and younger patients. The quality of life progressively improved in the course of diversion with [PCN] but deteriorated with stents. Our results demonstrated that [PCN] is superior to ureteral stents when diversion is indicated in cases of stone-induced hydronephrosis, especially in patients with a high temperature, as well as in males

Clinically insignificant residual fragments [CIRFs] after [ESWL]

To assess the significance of asymptomatic residual stone fragments of less than 4 mm [clinically insignificant residual fragments [CIRFs] after extracorporeal shock wave lithotripsy [ESWL]. Eighty-one patients were followed up for 6 to 60 months [mean 15] after ESWL to determine the fate of the CIRFs. -Of the 81 patients, 6 were lost to follow-up, leaving 75 patients. -During follow-up, fragments passed spontaneously in 18 patients, remained stable in 13 patients, and became clinically significant in 44 patients who developed one or more complications. For the latter patients, repeated ESWL was done in 16, percutaneous nephrolithotomy in 3, and ureteroscopic stone removal in 4 patients. The remaining 21 patients were treated conservatively with analgesics. -We found that: a]- 53% of the CIRFs located in the pelvis passed spontaneously, and most of the CIRFs in caliceal location became clinically significant. b]- as the stone burden and number of stone fragments increased, the risk of CIRFs becoming clinically significant increased. c]- The clearance rate was highest in the first 6 months. Finally, as the duration of follow-up increased, the rate of complications increased. Patients with residual stones after ESWL require close follow-up and timely adjuvant therapy. As the number and size of residual fragments increased, the risk of complications increased. A pelvic location was a favorable factor for spontaneous passage. Although the complete clearance rate of CIRFs with repeated ESWL was lower than for the operative interventions, most patients improved with this modality