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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.
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Extracorporeal Shock Wave Lithotripsy (ESWL) is one of the treatment options for renal and upper ureteric calculus; however, the outcome depends on multiple factors. Our study aims to evaluate the factors that may inuence ESWL outcomes in Indian patients with upper urinary tract calculi. Between 2018 and 2020, a total of 300 adult patients who underwent ESWL for renal and upper ureteral calculus sizing 5 to 20 mm were included in the study program. Patients with
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Background:To compare the treatment outcome of Silodosin alone and Silodosin with Tadalafil as a medical expulsive therapy (MET) of lower ureteric stone in western part of Rajasthan. Material And Methods:The study was conducted in a tertiary hospital of Dr. S.N. Medical College, Jodhpur over a period of 12 months (1st January, 2020 to 31st December, 2020). Out of 108 patients, 100 meet the inclusion criteria who were purposively assigned into 2 groups. 48 patients included in Silodosin alone group and 52 in Silodosin with Tadalafil group. Result:There was a significant higher stone expulsionrate in Silodosin with Tadalafil than Silodosin alone which was 88.46% vs75% respectively (P value 0.02). The mean stone expulsion time of Silodosin alone was14.33 (±3.1) days and Silodosin plus Tadalafil was 11.48(±2.3) days (P value 0.001). The episodes of pain in Silodosin alone were 0.7(±0.06) and 0.6(±0.2) in Silodosin with Tadalafil group that was statistically significant. Conclusion:The present study suggested that Silodosin with tadalafil combination therapy significantly increases ureteric stone expulsion rate and decreases the expulsion time and pain episodes than treatment with silodosin alone.
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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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Introduction: Extracorporeal shock-wave lithotripsy (ESWL)is an established non-invasive treatment modality for renaland ureteric stones. However, treatment outcome and efficacydepends on multiple factors like stone size, location and typeof machine used. We aimed to assess efficacy of ESWL asa primary treatment modality in renal and ureteric stones ina busy hospital setting having significant renal stone diseaseburden.Material and methods:1187 patients who underwent ESWLbetween January 2015 to December 2016 in our departmentwere included in the study. Patients with nephrolithiasis andureterolithiasis having functional kidney, without any absolutecontraindication to ESWL were included. Dornier Med TechCompact Delta 2 machines were used for all the patients.Stone localization was done using both fluoroscopic andultrasound- guided methods by same expert.Results: Out of 1187 patients,887 patients had solitary renalstones,170 had solitary ureteral calculus and 130 patients hadmultiple renal calculi. Stone size ranged from 8mm–20mm.Renal pelvic stones, upper calycial stones and proximalureteric stones had stone free rate of 84%,86% and 82.5%respectively. 89% and 84% of patients were stone free whensize of stone was between 8-12mm, it decreased to 77% and73% when size increased between 13-16mm for kidney andureteric stones respectively.Conclusions: ESWL is an effective primary treatmentmodality for appropriately selected patients with stone sizeless than 2 cm in favorable location with a normal functioningkidney. Use of both fluoroscopic and ultrasound imagingimproves localization of stones thus improving success. Itis an important modality in hands of urologist treating hugevolume of urolithiasis patients in busy hospitals with longwaiting list and with limited resources.
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Introduction: Urinary stone disease is a major health problemnot only because of high prevalence but also because it affectsthe young and productive population of the society. The currentstudy was performed to assess and compare the expulsiveeffects of orally administered Afluzosin as medically expulsivetherapy for distal ureteral calculi less than 8 mm in diameterwhen administered upto 21 days after the first painfulmanifestation.Materials and Methods: A total of 60 patients with distalureteric calculi were enrolled in the study and were divided intwo groups. The control group comprised of 30 patients withdistal ureteric calculi who were given Cap. Becosule (Vitamin BComplex) (Placebo) once a day for clearance of ureteric calculiwith plenty of fluids and analgesics as and when required. Thestudy group comprised of 30 patients with distal ureteric calculiwho were given Tab. Alfuzosin hydrochloride 10 mg once aday for clearance of ureteric calculi with plenty of fluids andanalgesics as and when required. The outcome was measuredin terms of passage of calculi, no. of days taken for passage ofcalculi and no. of analgesic tablets consumed until passage.The statistical analysis was done using chi-square test forproportions and Independent samples "t" test for comparingmeans between the two groups and a p value less than 0.05indicated statistically significant difference.Results: In study group, stone was passed within 21 days ofstudy period in 26 (86.7%) subjects whereas in control group, itcould pass in only 14 (46.7%) patients thus showing asignificant statistical difference between two groups (p=0.001).Mean analgesic intake was 6.63±1.38 tablets in study groupand 8.63±3.26 tablets in control group, thus showing that themean analgesic intake was significantly high in control groupas compared to study group (p=0.009).Conclusion: In our study Patients in Alfuzosin groupdemonstrated a higher incidence of spontaneous stonepassage, more rapid stone passage and a decreased need foranalgesic. This selective α1 blocker should therefore beincluded in different schedules used worldwide, when aconservative approach to this very common urological problemis considered.
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Background and Objectives: Though medical expulsive therapy for ureteric stones is increasingly used these days, some recent randomized controlled trials have questioned its benefit. This study evaluates the result of treatment of ureteric stones with tamsulosin. Materials and Methods: This prospective study involved ultrasonographically confirmed cases of uncomplicated unilateral ureteric stones. All patients received tamsulocin 0.4 mg daily for 2 to 6 weeks. The primary end point was stone expulsion. The secondary endpoints were the use of analgesics and adverse events. Results: One hundred and sixty two patients completed the study. Ninety seven patients were male and male to female ratio was 3:2. The mean age was 34.9 ± 9.8 (range: 18-71) years. The mean stone size was 6.17 ± 1.68 (range: 3.3-11.2) mm. By the end of 2, 4 and 6 weeks, cumulative stone expulsion rate was 110 (69.1%), 121 (74.7%) and 126 (77.8%) respectively. For the 49 stones of size £ 5 mm, the expulsion rate was 47 (95.9%) by the end of 6 weeks. The expulsion rates for stones of size > 5 - 7 mm, > 7 – 9 mm and ³ 9 mm were 59 (85.5%), 17 (53.1%) and 3 (25%) respectively by the end of 6 weeks. Lower ureteric stones had the highest expulsion rate of 106 (87.6%) by the end of 6 weeks, and the rate was lowest for upper ureteric stones (34.6%). Ten (6.1%) patients required additional analgesics during the course of treatment. Eleven (6.8%) patients complained of mild light-headedness and dizziness which subsided in a few days. Conclusion: Tamsulocin appears to facilitate expulsion of ureteric stones especially the distal ones. The benefit of tamsulocin seems to be maximum for the stones of size up to 9 mm. Further large scale randomized controlled trial should better define the real benefit and more rationale use of tamsulocin in routine clinical practice.
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Objective To evaluate the effect of one step flexible ureteroscopic lithotripsy for incarcerated upper ureteral calculi.Methods The clinical data of 80 cases of incarcerated upper ureteral calculi were retrospectively analyzed between August 2015 and September 2016.Theone step flexible ureteroscopic lithotripsy was used in 40 cases (one step group),including 22 male cases and 18 female cases.The average age was (40.0 ± 9.5) years.The maximal stone diameter was (i.8 ± 0.5) cm.The widest width of the ureter above the stone was (2.5 ± 1.1) cm.The CT value of stone was (1 089.0 ± 111.3) HU.Two step method was used in 40 cases (two step group),including 21 male cases and 19 female cases.The average age was (41.0 ± 10.7).The maximal stone diameter was (1.7 ± 0.6)cm.The widest width of the ureter above the stone was (2.3 ± 0.9) cm.The CT value of stone was (1 002.0 ± 97.2) HU.During the one step flexible ureteroscopic lithotripsy,only flexible ureteroscope was used to crush the stone,no matter whether the stone located in the ureter or return to the renal pelvis.During two stepmethod,the rigid ureteroscopy was firstly used for crushing the stone in the ureter.When the stone return to the renal pelvis,the rigid ureteroscopy was change into flexible ureteroscope for continuous crushing the stone.Compared two groups' operating time,2 weeks stone clearance rate and the cases of fever after operation.Results The mean operative time in the one step group was (37.45 ± 11.34) min.The mean operative time in the two step group was (55.07 ± 13.57) min.The difference was statistically significant (P ＜ 0.05).The number of infection 2 cases in one step group and 9 cases in two step group.The difference was statistically significant (P ＜ 0.05).2 weeks stone clearance rate was 87.5％ (35/40) in one step group and 82.5％ (33/40)in two step group.There was no significant difference between two groups.Conclusions Flexible ureteroscope one step method is a safe and effective alternation for incarcerated upper ureteral calculi.
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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.
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Anomalies of the urinary system constitute approximately 30% of all the congenital malformations. There are various associated anomalies involving number, size, shape, position and vascularity of the kidneys. Unascended kidneys refers to a halt in the migration of the kidneys during their normal embryological development. Defect in the ascent of the kidneys are closely related with variations in the branching pattern of aorta. Here we report a case of an unilateral unascended right kidney in a male cadaver encountered during routine medical dissection. A left sided ureteric calculi was also seen as an incidental finding in the same cadaver. Ureterolithiasis occurs worldwide in all sets of population with 80% of the stones found in the male sex in the age group of 30- 60 years. There are various factors which favour the formation of ureteric calculi which includes geographical, socio-economical as well as the mineral content of water consumed and some general medical causes. An attempt has been made to document the causes for this variation and the preventive measures that can be adopted to prevent the formation of ureteric calculi.
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Objective To investigate the safety and efficacy of percutaneous nephrolithotomy ( PCNL ) combined with ureteroscopy in supine anterolateral lithotomy position for the management of complicated upper ureteric calculi . Methods From January 2009 to October 2012, 67 patients underwent PCNL combined with ureteroscopy in supine position under general anesthesia . Renal calculi was treated with PCNL , and then ureteroscopy was used to break and wash out the residual calculi . Results All the 67 surgeries were completed successfully .Operation time was 46 -106 min ( average, 76 min); stone clearance rate was 92.5%(62/67);residual stone was found in 5 cases and were completely removed two weeks after ESWL .No massive hemorrhage , ureteral avulsion, pleura, abdominal organ injury or other complications occurred . Conclusions PCNL combined with ureteroscopy in supine anterolateral lithotomy position for the treatment of complicated upper ureteric calculi is safe and effective .It has shorter operative time and is convenient for the patients .
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Objective To investigate the feasibility and safety of minimally invasive pereutaneous nephro-lithotomy(MPCNL) in treating impacted upper ureteral calculi. Methods 50 cases with impacted upper ureteral cal-culi treted with MPCNL were analyzed retrospectively. Results All cases were rendered stone free at one session, clearance rate was 100%, 1 case required transfusion,no other major complications was observed. Conclusion MPC-NL was safe and effective in treating impacted upper ureteral calculi with a high clearance rate.
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Objective To evaluate the efficacy of ureteroscopic pneumatic lithotripsy for ureteric calculi.Methods From January 2003 to June 2007,221 patients with ureteric calculi underwent ureteroscopic pneumatic lithotripsy in our hospital.Under continuous epidural anesthesia combined with spinal anesthesia,the surgery was performed in lateral lithotomy position.Double-J catheter was used for drainage after the operation.Results The mean operation time was 55 minutes(ranged from 15 to 118 minutes).Among the patients,the calculi were found in the upper ureter in 16 cases,middle segment in 52 cases,and lower ureter in 153 cases.A total of 228 stones in the 211 patients were all fragmented with a success rate of 100%.The discharging rate was 95.5%(211/221).ESWL was used in 7 cases with unsatisfied outcomes and 3 patients who had ipsilateral renal calculi.A 3-to 6-month follow-up was achieved in 189 of the patients,who had no recurrence during the period.Conclusions Ureteroscopic pneumatic lithotripsy is a minimal invasive and effective treatment for ureteric calculi.Postoperative ESWL is an alternative which can increase the rate of stone clearance.
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To compare the efficacy and morbidity of laparoscopic ureterolithotomy and open ureterolithotomy via the posterior lumbar approach. Meterials and Methods: A retrospective study was performed by reviewing patient records. Ten patients in the laparoscopic ureterolithotomy group were compared with 15 patients in the open ureterolithotomy via lumbotomy incision group. Twelve patients who had flank ureterolithotomy comprised a control group. Details of age, sex, size and site of the stone, haematocrit, blood urea nitrogen, serum creatinine, degree of hydronephrosis of the affected kidney, contralateral renal function, operative time, operative complication, the amount of postoperative analgesics and length of hospital stay were all compared. Statistical analysis was carried out by the Chi- square test, Anova and LSD multiple comparisons. Results: The preoperative status of the three groups were similar. When the ureterolithotomy via lumbotomy group was compared with the control group (flank ureterolithotomy) the results were similar except that ureterolithotomy via lumbotomy required less analgesics postoperatively (mean 50 mg vs 104, p < 0.001). Ureterolithotomy via lumbotomy patients required the same analgesics as laparoscopic ureterolithotomy. However, laparoscopic ureterolithotomy had a longer operating time (mean 181.5 min vs 88, p < 0.001) and longer period of urine leak postoperatively (mean 6.6 days vs 2.4, p < 0.003) when compared with ureterolithotomy via lumbotomy. Conclusion: Ureterolithotomy via lumbotomy offers similar low discomfort postoperatively compared with laparoscopic ureterolithotomy but had a shorter operating time and less complications.
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Objective To evaluate the surgical method and curative effect of minimally invasive percutaneous nephrolithotomy(MPCNL) in treatment of impacted proximal ureteric calculi.Methods 45 cases of proximal ureteric calculi treated with MPCNL were studied retrospectively.Percutaneous nephrostomy was established under the guide of X-ray,B-ultrasound and naked eye,and the nephropathy was extended to F16 through invasive percutaneous.Stones were taken out by ureteropyeloscopic pneumatic lithotripsy with help of hydraulic perfusion pump.Results The surgical time was 15～110 min with the average of 42 min after percutaneous nephrostomy.The average blood loss volume was 30 mL;no severe complications were occurred in the intra-or post-operative time.The rate of complete clearance of stones was 100% in first attempt.The mean hospital stay was 9 d,and the mean postoperative hospital stay was 3.5 d.Conclusion MPCNL used to treat the impacted proximal urethral calculi have satisfied effects and a lot of merits.
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Objective To evaluate the surgical method and curative effect of minimally invasive percutaneous nephrolithotomy(MPCNL) in treatment of impacted proximal ureteric calculi and giant renal pelvic calculi with moderate or severe hydronephrosis by non-imaging in localization.Methods 52 cases of calculi treated with MPCNL were studied retrospectively.Percutaneous nephrostomy was established by non-imaging in localization(naked eye) according location of kidneys,length of 12th ribs,degree of hydronephrosis and condition of calculi,and the nephropathy was extended to F16 through invasive percutaneous.Stones were taken out by ureteropyeloscopic pneumatic lithotripsy with the help of hydraulic perfusion pump.Results The operative time was 32~140min with the average of 112min.The average blood loss volume was 45mL.No severe complication occurred in the intra-or post-operative time.The rate of complete clearance of stones was 96 % in first attempt,and the residual stones passed out by themselves after the double "J" tube was pulled out in cases.The mean hospital stay was 9 days,and the mean postoperative hospital stay was 4.2 days.Conclusion To treat the impacted proximal ureteric calculi and giant renal pelvic calculi with moderate hydronephrosis or severe hydronephrosis,some skilled doctors can appropriately use the method of MPCNL by non-imaging in localization,since the method can reduce the harm by X-ray,and save medical expenses.