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Background: The lifetime risk of kidney stones is between 5% and 10% and rates of recurrence are as high as 50%. Majority of the ureteric stones (70%) are found in the lower third of the ureter. Available setup, type, size of the stone, and expertise of the surgeon are the major factors affecting the treatment modality. Medical expulsive therapy has shown promising results in previous studies. Aim of the study was to assess the efficacy of tamsulosin and deflazacort combination therapy for stone expulsion in relation with site and size of stones.Methods: A total of 97 patients with ureteric calculi of size 10 mm or less attending the urology out-patient department were included. Received medical expulsive therapy using tamsulosin (0.4 mg) and deflazacort (30 mg) for 7 days. Patients were evaluated for stone expulsion on 7th day by non-contrast computed tomography of kidney ureter bladder. Site, side and size of stones were noted.Results: Ureteric calculi was more prevalent in the age group of 21-30 years 38 (39.2%). Male preponderance was observed (76.28%) with male female ratio being 3.2:1. Lower site 64 (65.97%) ureteric calculi were most common. The majority had a stone size of 4-6 mm (42%). Stones were expelled on 7th day in 69 (71.13%) patients. Expulsion rates were highest for the stone size of 2-4 mm (94.4%) followed by 4-6 mm (88.1%). The highest expulsion rates were observed for Lower ureteric stones (84.4%).Conclusions: Medical expulsive therapy using tamsulosin and deflazacort is an effective treatment modality for the management of ureteric stones, especially those present in lower ureter and those ≤8 mm in size.
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Context: Gallbladder carcinoma (GBCA) is the fifth most common types of gastrointestinal malignancy and is the most common malignancy of the biliary tract. Cholelithiasis, gallbladder polyps, porcelain gall, and choledochal cysts are common known associations with GBCA. Because of the better understanding of the etiopathogenesis, the traditional nihilistic attitude toward the prognosis has, over the years, given way to greater interest and hope for treating the disease. Long-term survival has been reported in patients with resectable lesions in the hands of expert hepatobiliary surgeons. Objective: This prospective observational study was conducted at a tertiary referral hospital of Eastern India on patients with the diagnosis of GBCA. The main objective was to assess the incidence of gallstones in patients with GBCA, and the relationship, if any, between the size and number of stones and GBCA in our patient cohort. Materials and Methods: This prospective observational study was conducted, over a period of 2 years, at a tertiary referral hospital of Eastern India which caters to patients from all the neighboring districts. A total of 54 patients with the diagnosis of GBCA were included in the study. Data on their demographic and clinical profile, the incidence of associated gallstones, their size (<3 or ≥3cm), and number (solitary or multiple) were collected. Known predisposing factors of GBCA, if any, in those presenting without stones were noted. Results: GBCA was found to afflict females 2.4 times as frequently as males. Patients, irrespective of their sex, were mostly in their sixth decade. Approximately three-fourth of the cases had associated cholelithiasis. The number of stones had no correlation with the disease. However, contrary to available published data, stones <3 cm were significantly more common in our study cohort. Conclusion: The results of this study reaffirm that cholelithiasis is a strong predisposing factor for GBCA and females with gallstones in their sixth decade, are more at risk. Although number of stones was not found to be an independent risk factor, patients with stones <3 cm (mostly multiple) were found to be more at risk in our study
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Background: Acute renal colic during pregnancy is associated with significant potential risks to both mother and fetus. Diagnosis is often challenging because good imaging options without radiation use are limited. Management of diagnosed nephrolithiasis is unique in the pregnant population and requires multi-disciplinary care. Aim: To study the metabolic alterations during pregnancy that may promote kidney stone formation, the complications associated with acute renal colic in the pregnant state, and our proposed diagnostic and management algorithms when dealing with this clinical scenario. Materials and methods: This observational study was done in 2017-2018 at, Department Of Urogynecology, Institute of Social Obstetrics, Government Kasturba Gandhi Hospital, Chennai. Totally 22 pregnant women were included in the study. Charts of the patients were retrospectively reviewed and observations included age, presenting symptoms, diagnostic methods, urologic intervention, calculi location, stone size, trimester of diagnosis, and postpartum treatment. Results: The diagnosis of urolithiasis was two (11.1%) in the first trimester, six (33.3%) in the second trimester, and 10 women (55.5%) in the third trimester. Of the 20 stones, nine were on the right side and 11 were on the left; two patients had bilateral urinary stones detected. Flank pain was the most common clinical presentation in 17 women, gross hematuria in five, fever in four, and urinary frequency in one patient. In laboratory tests, microscopic hematuria was found in 10 cases, pyuria in six, and leukocytosis (leukocyte cell count > 10,000/mm3 ) in five. Diagnostic imaging was based on the transabdominal US. In 14 cases, renal or ureteral stones were detected by the US. The other four patients had hydronephrosis on the US without definite detection of the ureteralstones. Conclusion: Women, in general, appear to be developing urolithiasis with increasing frequency. Consequently, it is expected that the incidence of pregnant women with stones may also increase. A T. Srikala Prasad. A study on diagnosis and management of urinary calculi in pregnancy. IAIM, 2019; 6(3): 248-252. Page 249 diagnostic and therapeutic approach that takes into account the individual patient’s symptoms, stage of pregnancy and stone characteristics should be the intent in each case.