A study of predicting factors and medical expulsion therapy for solitory lower ureteric calculi

Background: The aim of our study is to evaluate the outcome of medical expulsion therapy (MET) for lower ureteric calculi and asses the clinical, laboratory and radiological factors that predict conservative approach. We evaluated the efficacy of combined drug therapy with alpha 1 adrenergic receptor antagonist tamsulosin and corticosteroid deflazacort for MET therapy for lower ureteric calculi. Methods: A prospective randomized control study was conducted in the department of surgery urology wing on out patients (OPD) basis at IIMSR Medical College Warudi District Jalna a tertiary referral center after approval from the ethical committee. The study conducted between 01 January 2020 to 31 December 2023 over period of three years. Total 76 cases included with the age 18 years old and above. The patients were examined weekly with ultrasonography and kidney ureter bladder (KUB) for 4 weeks and the stone expulsion rate and time, pain episodes during follow-up period, total diclofenac dosage and the need for any intervention was noted close monitoring and timely follow up is mandatory counselling and selection of patient is key factor. Results: Stone expulsion with patients on MET was 84% which is higher as compare to another group 57%. Conclusions: Medical therapy with a combination of ?-adrenergic blocker and corticosteroid is associated with good stone expulsion rates and should be considered in all patients with lower ureteral stones of size less than 10 mm who are not having any contraindications for medical therapy provided close monitoring and timely follow up is mandatory counselling and selection of patient is key factor.

Factors associated with ultrasound diagnosed neurogenic bladder complications following spinal cord injury

@#secondary medical impairment following spinal cord injury(SCI). Ultrasound (US) of the kidneys, ureters and bladder(KUB) has been recommended as a useful, non-invasivesurveillance method with good diagnostic sensitivity. Thisstudy aims to understand US diagnosed NB complicationsand identify its associated factors.Methods: We enrolled all patients referred for SCIrehabilitation from 2012 to 2015 that fulfilled our studycriteria. Data that were retrospectively reviewed includeddemographic and clinical characteristic data; and US KUBsurveillance studies.Results: Out of 136 electronic medical records reviewed, 110fulfilled the study criteria. The prevalence of NB in our studypopulation was 80.9%. We found 22(20%) of the patientsshowed evidence of US diagnosed NB complications withthe mean detection of 9.61±7.91 months following initial SCI.The reported NB complications were specific morphologicalchanges in the bladder wall 8(36.4%); followed byunilateral/bilateral hydronephrosis 7(31.8%); bladder and/orrenal calculi 5(22.7%); and mixed complication 2(9.1%)respectively. Half of the patients with NB complications hadurodynamic diagnosis of neurogenic detrusor overactivitywith/without evidence of detrusor sphincter dyssynergia.We found co-existing neurogenic bowel, presence ofspasticity and mode of bladder management weresignificantly associated factors with US diagnosed NBcomplications (p<0.05), while spasticity was its predictorwith adjusted Odds Ratio value of 3.93 (1.14, 13.56).Conclusion: NB is a common secondary medical impairmentin our SCI population. A proportion of them had USdiagnosed NB complications. Co-existing neurogenic bowel,presence of spasticity and mode of bladder managementwere its associated factors; while spasticity was itspredictor.

Usefulness of Unilateral X-ray of the Kidney, Ureter, and Bladder in the Follow-up of Patients Treated with Extracorporeal Shock Wave Lithotripsy: Reduction of Radiation Exposure / 대한비뇨기과학회지

PURPOSE: The objective of this study was to assess the usefulness of a unilateral x-ray of the kidney, ureter and bladder (hemi-KUB), in the place of a full-KUB, in the follow-up of patients treated with extracorporeal shock wave lithotripsy (ESWL), and thereby reduce the radiation exposure for patients. MATERIALS AND METHODS: A total of 111 patients, who underwent ESWL, between March 2000 and July 2002, were enrolled onto the study. Patients with bilateral stones, or who had changed to another treatment model, were excluded. During the follow-up to the ESWL, we used the hemi-KUB method for the collimation of the radiation field. The numbers of hemi-KUBs during the treatment were recorded. The reductions in the exposure to the radiation dose, per patient, were calculated and analyzed according to the sizes and shapes of the stones. The typical doses were: for IVU (6 films), 2.5mSv; full-KUB film, 0.42mSv; and a hemi-KUB film, 0.21mSv. RESULTS: The total reduction in the doses of radiation exposure was 114.45mSv. The radiation doses, per patient, were reduced by a mean of 1.03+/-0.58mSv. The reduction in the dose of radiation exposure correlated well with the stone size (r=0.7082, p<0.05). The mean number of hemi-KUBs (mean reduction dose of radiation exposure), according to the stone size groups: these being 5-9, 10-19 and +/-20mm, were 3.82+/-1.76 (0.80+/-0.37), 6.52+/-2.10 (1.37+/-0.44) and 11.00+/-3.85 (2.31+/-0.81)mSv, respectively (p<0.05). Also, the mean number of hemi-KUBs (mean reduction dose of radiation exposure), according to the stone shapes, typed into I (less organized or lacy), IIa (spiculated), IIb (mulberry), III (round or ovoid) and IV (struvite or staghorn), were 2.77+/-0.85 (0.58+/-0.18), 4.48+/-1.86 (0.94+/-0.39), 4.83+/-1.43 (1.01+/-0.30), 7.54+/-1.36 (1.58+/-0.29) and 8.75+/-3.72 (1.84+/-0.78)mSv, respectively (p<0.05). Using the receiver operating characteristic curve, the cut-off value, of a stone size that could be used to determine the risk group whose radiation exposure exceeding 5mSv (personal permissible dose/year), was 23.52mm, but when using a full-KUB this was 7.97mm. CONCLUSIONS: The use of hemi-KUB is a simple and easy method to reduce the radiation exposure in the follow-up of an ESWL, especially in patients with stones larger than 7.97mm in size, with a round-ovoid or staghorn shape.

DIAGNOSTIC METHOD OF UROLITHIASIS PATIENTS IN EMERGENCY DEPARTMENT

Nephrolithiasis is one of the most common disease seen in the Emergency Department. Among the patients who visited in the Emergency Department with acute abdominal pain, many people were suspected urolithiasis. Because of limitation of diagnostic method on Emergency Department we planned this study in order to confirm the our accuracy of diagnosis and the possibility of misdiagnosis. During 5 months from April 1996 to August 1996, the 189 patients was suspected the urolithiasis. Among this patient, 51 cases was excluded due to incomplete study. After performing P/ex, U/A KUB in the Emergency Department, they were followed out patients department of Urology and performed Intravenous Pyelogram. The sensitivity and specificity for KUB were 84.5% and 94.0%, respectively. The positive predictive value was 93.8%, the negative predictive value was 93.8%. Diagnostic accuracy of urolithiasis in our Emergency Department is 89.1%. There was no relationship between urinary occult blood and KUB or IVP. There was no relationship between degree of occult blood and diagnosis of urolithiasis. For differential diagnosis of urolithisis, emergency ultrasound and IVP will be available. So combination of this diagnostic methods will improve accuracy and safety of diagnosis and treatment of urolithiasis.

The Predictability of Stone Composition According to the Radiodensity of Urinary Stone on KUB Film / 대한비뇨기과학회지

A plain abdominal X-ray film (simple abdomen or KUB) is often used to display several types of urinary stones in vivo, or at least for a differentiation between calcium-containing 'radio-opaque' and calcium-noncontaining 'non-opaque' stones. We evaluated whether a KUB film could offer the information on composition of urinary calculi or not. The radiodensity of stone itself, the ratio of radio-opacity between the stones and the 2nd lumbar vertebra or lower renal pole parenchyme were measured in each 20 patients with renal stones above 1cm in diameter and variable compositions. However, such a definite distinction could not be resulted in our study. Therefore, we think that it is not possible to achieve a predictability of stone composition by measuring of its radiodensity on KUB film.

Comparative study of risk factors in urinary stone patients with normal plain KUB or IVP patients in Buriram Hospital.

A comparative study of risk factors in urinary stone patients with normal plain KUB or IVP patients at surgical clinic and pediatric clinic of Buriram Hospital was done. In the pediatric clinic there were 34 urinary stone patients and 100 control patients. The findings were: age, language, vegetable intake, and drinking water per day (p > 0.05) made no significant difference but sex, type of rice eaten, type of animal meat, and type of water (p < 0.05) made a difference. In the surgical clinical there were 132 urinary stone patients and 88 control patients. The findings were: there were no significant differences between sex, vegetable intake, type of animal meat, type of water, and drinking water per day (p > 0.05) but made a significant difference age, language, and type of rice (p < 0.05). The one significant difference in both clinic was type of rice.