Novel semirigid ureterorenoscope with irrigation and vacuum suction system: introduction and initial experience for management of upper urinary calculi

ABSTRACT Objective: This study aims to design a novel semirigid ureterorenoscope with irrigation and vacuum suction system and a modified ureteral access sheath (UAS) named Sotn ureterorenoscope® (Sotn=ShuoTong Medical Company) to overcome the deficiencies of the current procedure and to improve the efficiency and safety of using Sotn ureterorenoscope® for treatment of upper urinary calculi. Materials and Methods: Fifty-eight patients, comprising 31 males and 27 females, were evaluated. The medical records of 58 patients with upper urinary calculi treated with Sotn ureterorenoscope® from March 2015 to June 2017 were retrospectively reviewed at the Second Affiliate Hospital of Guangzhou University of Chinese Medicine in China. The primary outcome was stone-free rate (SFR) assessed by computed tomography on the 1st day and one month after treatment. The secondary outcome was postoperative complication rate. Results: The mean and SD of operative duration was 48.5 (10.4) min, and the mean and SD of stone size was 15.6 (5.6) mm. The primary overall SFR was 89.7% (52/58) and 100% at 1 month follow-up. Complication, which was Clavien I (minor fever managed by antipyretic therapy), was detected in 1.7% (1/58) of the patients. Conclusions: Sotn ureterorenoscope® is technically feasible, efficacious and safe for treatment of upper urinary calculi because of its advantages of high SFR and low complication rates.

Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones?

PURPOSE: The objective was to determine whether stone density on plain radiography (kidney-ureter-bladder, KUB) could predict the outcome of extracorporeal shockwave lithotripsy (ESWL) for ureteral stones. MATERIALS AND METHODS: A total of 223 patients treated by ESWL for radio-opaque ureteral stones of 5 to 20 mm were included in this retrospective study. All patients underwent routine blood and urine analyses, plain radiography (KUB), and noncontrast computed tomography (NCCT) before ESWL. Demographic, stone, and radiological characteristics on KUB and NCCT were analyzed. The patients were categorized into two groups: lower-density (LD) group (radiodensity less than or equal to that of the 12th rib, n=163) and higher-density (HD) group (radiodensity greater than that of the 12th rib, n=60). Stone-free status was assessed by KUB every week after ESWL. A successful outcome was defined as stone free within 1 month after ESWL. RESULTS: Mean stone size in the LD group was significantly smaller than that in the HD group (7.5+/-1.4 mm compared with 9.9+/-2.9 mm, p=0.002). The overall success rates in the LD and HD groups were 82.1% and 60.0%, respectively (p=0.007). The mean duration of stone-free status and average number of SWL sessions required for success in the two groups were 21.7 compared with 39.2 days and 1.8 compared with 2.3, respectively (p<0.05). On multivariate logistic analysis, stone size and time to ESWL since colic and radiodensity of the stone on KUB were independent predictors of successful ESWL. CONCLUSIONS: Our data suggest that larger stone size, longer time to ESWL, and ureteral stones with a radiodensity greater than that of the 12th rib may be at a relatively higher risk of ESWL failure 1 month after the procedure.

Extra corporial shock waves ureteral lithotripsy

Our study included 200 patients who have ureteric stones, these patients were divided according to their age 180 Adults 20lnfants and each category was studied separately. The ureteric stones in infants was distributed as follows: 7 cases at the upper ureter, 5 cases at the middle of the ureter, 8 cases at the distal ureter; wheras they were distributed in 76 cases at the upper ureter, 64 cases at the middle of the ureter, 40 cases at the middle of the ureter. The essential symptom in infants was fever, on the other hand the essential symptom in adults was pain [Renal colic]. Abdominal X-Ray and Echography were performed in all infants and adults, but IVP was performed in most of them. The stones were divided according to their diameter into three groups: < 0.5cm, 0.5-1cm, > 1cm, and according to their density into four groups: [less than bone density, equal to bone density, more thanbone density, lucent]. The stones were studied according to their site [proximal, medium, distal] and compared with their diameters, densities, assisted methods, the interval between symptoms onset and diagnosis and the interval between the diagnosis and lithotripsy performance. The recurrence of lithotripsy of 5 times was the discriminatory line between the success or the failure of lithotripsy in adults, whereas this line was 3 in Intravenous or intramuscular pain relieving was used in adults with scant cases of general anesthesia, but in infants the all cases was performed under general anesthesia. the interval between one lithotripsy and other was two weeks. The evaluation of patients was performed through abdominal X-Ray one-week later. The number of shock waves was 4000 in every lithotripsy for adults and 2500 for infants. The success rate of ESWL for adults was%78.88 and more accurately it was%92.1 at the upper ureter,%84.37 at the middle. ureter,%45 at the distal ureter; whereas the success rate of ESWL for infants was%85 and more accurately it was%l00 at the upper ureter,%100 at the middle ureter,%62, 5 at the distal ureter. The stones less than 1cm in diameter has the best success rate and was needed less numbers of lithotripsy in compared with stones more than 1cm in diameter. The density of stones didn't play any role in determination of the success rate of the ESWL. The interval between symptoms onset and the diagnosis, and the interval between the diagnosis and lithotripsy performance has role in the determination of the success rate of the ESWL and the number of recurrence of lithotripsy Which were needed for each stone. The stones of upper and middle ureter were the most responsible to tripsy in comparing with the stones of distal ureter; especially if their diameter was more than 1cm. Generally, the factors which play a role in the success of ESWL and the determination of number of recurrence of lithotripsy were-The site of the stones-The diameter of the stones-The speed of the diagnosis-The speed of the treatment The extra corporeal lithotripsy success rate in infants was better than in adults

Unenhanced helical CT scan for ureterolithiasis

The study was carried out from November 2002 to January 2004 and included patients who presented with flank pain at the Aga Khan University Hospital. One hundred and twenty patients were excluded from the study that were less than 15 years of age, pregnant or had history of trauma and infection. A total of 80 out of these 200 patients were included in this study that had a CT diagnosis of ureteric calculus after a UEHCT. In all those 80 patients with diagnosis of ureteric calculus on CT scan was confirmed later on either IVU, stone passage in the urine, ESWL [extracorporeal shock wave lithotripsy] or on the ureteroscopic removal of calculus. The images were interpreted for site, size and location of ureteric calculus, hydronephrosis, hydroureter, perinephric stranding, periureteral stranding, nephromegaly and incidental findings. The age range was 15-69 years, with a mean age of 37.5 years. Out of 80 patients, 32 [40%] patients presented with right sided flank pain and 48 [60%] of the patients had left sided flank pain. In 12 [15%] patients, calculi were present in the proximal ureter, in 24 [30%] in the mid ureter and in 44 [55%] in distal ureter. Most of the stones were between 3-5 mm size range [47%]; 20% stones were less than 3 mm in size and 32.5% of stones were more than 5 mm in size. Most common secondary sign was perinephric stranding seen in 48 patients [60%]. The second most common secondary sign was periureteral stranding seen in 44 [55%] patients. In 30 of the patients [37.5%] hydronephrosis was observed. In 18 [22.5%] hydroureter was present. Nephromegaly was observed in 2.3% of the patients. In 2 of 120 patients in which CT was negative, ureteric calculus was present on IVU which was carried out 3 days after UEHCT. In 2 of 120 patients in which CT was negative for ureteric calculus, ureteric calculus was present on IVU which was carried out 3 days after UEHCT. The sensitivity, specificity, positive and negative predictive values of unenhanced helical CT scan for detection of ureteric calculi was 97.5%, 98.3%, 97.5% and 98.3% respectively

Unenhanced Spiral CT in Acute Ureteral Colic: A Replacement for Excretory Urography?

OBJECTIVE: To compare the usefulness of unenhanced spiral CT (UCT) with that of excretory urography (EU) in patients with acute flank pain. MATERIALS AND METHODS: Thirty patients presenting with acute flank pain under-went both UCT and EU. Both techniques were used to determine the presence, size, and location of urinary stone, and the presence or absence of secondary signs was also evaluated. The existence of ureteral stone was confirmed by its removal or spontaneous passage during follow-up. The absence of a stone was determined on the basis of the clinical and radiological evidence. RESULTS: Twenty-one of the 30 patients had one or more ureteral stones and nine had no stone. CT depicted 22 of 23 calculi in the 21 patients with a stone, and no calculus in all nine without a stone. The sensitivity and specificity of UCT were 96% and 100%, respectively. EU disclosed 14 calculi in the 21 patients with a stone and no calculus in eight of the nine without a stone. UCT and EU demon-strated secondary signs of ureterolithiasis in 15 and 17 patients, respectively. CONCLUSION: For the evaluation of patients with acute flank pain, UCT is an excellent modality with high sensitivity and specificity. In near future it may replace EU.

Laparoscopic ureterolithotomy for upper ureteric calculi.

Laparoscopic ureterolithotomy was performed on 10 patients with upper ureteric stones indicated for open ureterolithotomy after failed prior minimally invasive approaches. Stone size ranged from 7 to 15 mm. (mean 9.3). The routes of approach were all done transperitoneally except in one case in which the retroperitoneal route was initially attempted and later converted to transperitoneal route due to contracted space and unclear landmarks. Stones were all removed successfully with the operating time ranging from 120 to 270 min. (mean 181.5). The only significant complication encountered was urine leak interval postoperatively which were long in 4 patients in whom ureterotomy was not sutured. The longest urine leak interval was seen in a patient whose ureterotomy was neither sutured nor stented. Postoperative pain was rewarding in that seven patients required a single dose of 50 mg of pethidine, two required only oral paracetamol and one required no analgesic at all. Postoperative hospital stay ranged from 5 to 23 days which was actually overwhelmed by urine leak complication. Recovery period was satisfactory which ranged from 10 to 28 days (mean 18.1). Overall laparoscopic ureterolithotomy offers an alternative procedure to open ureterolithotomy with the advantages of minimal postoperative pain and short recovery period.

Ultrasonography in acute flank pain.

In 58 patients with acute recurrent or persistent flank pain, straight x-ray (kidney, ureter, bladder region) detected stones in the urinary tract in 50 cases (86.2%), whereas ultrasonography detected stones in the urinary tract in 55 patients (94.8%). Ultrasound also detected unilateral hydronephrosis in 20 patients (34.48%). The presence of calculus was subsequently proved by intravenous urography/surgery or spontaneous passage. Ultrasonography is safe, quick, reliable and most effective diagnostic tool in such cases in rural areas. Intravenous urogram should be reserved for cases which need surgical intervention.

Ureteral triplication associated with an ureteral stone

A case of type I ureteral triplication is reported and a brief review of the literature is presented

Management of lower ureteric calculi: experience with ureteroscopy

The choice of management of lower ureteral calculi remains a challenge to the urologist. Endoscopic removal of ureteric stones is being increasingly attempted by urologists. This report aims at identifying some of the factors that may affect the outcome of the procedure, providing guidelines to improve the results and to reduce complications. The present study included 30 patients with lower ureteral stones on whom ureteroscopic extraction was attempted. The stone size was 7 mm X 5 mm on the average. The overall success rate was 80%. No major complications resulted from the procedure. Surgical removal of the stone was done in 3 [10%] who had impacted stones. Careful attention to the details of ureteral dilation, prior to introduction of the ureteroscope, is essential in order to avoid complications