Is a contrast study really necessary prior to ureteroscopy?

This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities.

usefulness of inter-renal resistive index difference in diagnosing acute unilateral ureteric obstruction due to calculus

To evaluate the usefulness of inter-renal resistive index difference in diagnosis of acute unilateral ureteric obstruction due to calculus. Case Control Study was conducted in Department of Radiology, Combined Military Hospital Lahore, from August 2005 to February 2006. Sixty patients were divided in two groups of 30 each group I, 30 patients with unilateral acute ureteric colic due to ureteric calculus; and group II, 30 patients having no symptoms and with a normal ultrasound [as controls]. Interlobar arteries were examined by Colour Doppler ultrasound in upper, mid and lower renal pole with a two to five millimetre sample volume to calculate average resistive index. Inter-renal resistive index difference [deltaRI] was then calculated. Statistically significant difference was observed in the inter-renal resistive index difference [deltaRI] measurements with mean value in the case group of 0.09 compared to 0.021 in controls. Average intrarenal resistive index measurement in the obstructed kidney was .69 compared to 0.58-0.59 in the control group. Measurement of inter-renal resistive index difference in patients with ureteric colic improves diagnostic accuracy of ultrasound in distinguishing between obstructive and non-obstructive dilatation

Ocho años de experiencia en el tratamiento de la litiasis renoureterales mediante litotricia extracorpórea con Litotriptor electrohidráulico (Tripter compac) / An eight-year experience with the treatment of renouretheral lithiasis using extracorporeal lithotripsy with electro-hydraulic lithotritor (Triper compac)

Urinary lithiasis is one fo the most frequent disorder of the urinary tract, predominant in males and in their formation are involucrate many factors such as age, inheritance, diet, scant ingestion of fluids and sedentarity. Extracorporeal lithotripsy has become the method of choice for urinary lithiasis. The objective of this report is to present the author's experience with the treatment of urinary lithiasis using extracorporeal wave lithotripsy. From 1997 through 2005 we have treated 1456 patients suffering renouretheral lithiasis with our equipment Triper compac. Successful results were obtained in 96 por ciento in interior uretheral calculi, 94 por ciento for medial calculi and 96 por ciento for upper calculi. Several references related to this procedure are commented in the article

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

Transverse ureterotomy in open ureterolithotomy

Open ureterolithotomy is now a seldom performed operation but is still occasionally necessary. We report on the transverse ureterotomy (TU) in this procedure and its effect on reducing morbidity. Results from 100 cases of TU for stone disease since 1976 were compared with those from 50 ureterolithotomies using the standard longitudinal ureterotomy (LU) performed during the same period. The parameters considered were urinary leakage, length of hospital stay and ureteric narrowing as assessed on intravenous urogram at three months. The cases utilizing TU were associated with significantly less urinary leakage, a shorter hospital stay and no ureteric narrowing. Transverse ureterotomy for stone disease significantly reduces the morbidity associated with the operation when utilizing the standard LU. The fear of transecting the ureter may be overcome by good exposure and gentle careful dissection. We suggest that TU be used for open ureterolithotomy

Valor de la tomografía computada en los pacientes con posible sospecha clínica de urolitiasis / Diagnostic value of unenhanced helical CT in patients with urolithiasis

El objetivo del presente trabajo es evaluar la efectividad de la tomografía computada helicoidal (TC) sin contraste oral ni endovenoso para la detección y el manejo de los pacientes con sospecha clínica de urolitiasis. Se estudiaron 60 pacientes con presunción diagnóstica de cólico renoureteral. A todos se les efectuó tomografía computada helicoidal sin contraste oral ni endovenoso. La tomografía computada fue leída para la presencia o ausencia de litiasis. El diagnóstico definitivo fue efectuado mediante seguimiento en todos los casos. Con los resultados obtenidos el valor predictivo positivo de una tomografía computada es del 98 por ciento y la certeza global un 93 por ciento. En los pacientes con sospecha de litiasis, debido a que la TC de árbol urinario es sencilla, eficaz y sin contraindicaciones, debe formar parte del protocolo de estudio de éstos pacientes

Ureteral calculi during pregnancy: review of the management at Ramathibodi Hospital.

OBJECTIVE: To review our experiences with diagnosis and management of symptomatic ureteral calculi complicating pregnancy. MATERIAL AND METHOD: Medical records of all pregnant patients documented with symptomatic ureteral calculi treated at the Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital from 1990 to 2000 were reviewed. Presenting symptoms, diagnostic studies and management of ureteral stone were evaluated. RESULTS: Twenty patients were found in this study with the mean age of 27.5 years (18-36). The mean gestational age at presentation was 18.5 weeks (12-33). Severe flank pain was the common presenting symptom (100%), 60 per cent were on the right side and 40 per cent were on the left side, 20 per cent had associated fever and 20 per cent had irritative voiding symptoms. All of the cases had micro or macroscopic hematuria. Ultrasonography was the initial test confirming the diagnosis and visualized stones were obtained in 60 per cent of the cases. Plain KUB film was done in 6 cases and stones could be seen in 5 cases (83%). Limited IVP was done in 3 cases and the diagnosis could be done in all of them (100%). Spontaneous passing of stones was noted in 14 cases (70%) and double J stents were placed in 6 cases. Ureterolithotomy was done in 2 cases and percutaneous nephrostomy with subsequent definite stone treatment in the post partum period was done in 2 cases. No abortion and no congenital anomalies of the infant were noted. Four cases had premature labor but there was no correlation with the procedures performed for treating the ureteral stone. CONCLUSION: This study provides evidence for effectiveness of diagnosis and treatment of ureteral stone during pregnancy. The appropriate management may be helpful to reduce morbidity of urinary calculi during pregnancy.

Formação de cálculo uretral ao redor de um corpo estranho: relato de um caso / Formation of an urethral calculus around a foreign body: a case report

Os cálculos uretrais primários são raros no ocidente. O seu desenvolvimento freqüentemente está associado a alterações prévias do fluxo urinário, como divertículos uretrais, áreas de estenose ou corpos estranhos impactados. Os autores relatam um caso de um paciente de 77 anos de idade que se apresentou com queixa de retenção urinária aguda e dor na região genital. O diagnóstico de uretrolitíase foi feito e, mediante estudos radiográficos, um objeto estranho, cilindro de madeira, foi identificado no interior do cálculo.

Current evaluation and management of renal and ureteral stones

A systematic clinical approach is required for the diagnosis and management of renal and ureteral stones. The presenting symptoms, past medical history, medications, and physical examination all provide clues to the diagnosis of urinary stones. In the acute setting, noncontrast helical computerized tomography has emerged as the first line imaging test for renal colic. More traditional imaging tests are also important in the management of stone disease. After making the diagnosis of a urinary stone, the urologist should discuss the advantages and disadvantages of all treatment options with the patient. For most stone patients today, many equally effective treatment approaches can exist for the same problem. To help direct surgical management, guidelines for stone management have been devised. With technologic advances, stone treatment has improved and complications have decreased. While patient care has been significantly impacted by use of effective endourologic techniques, patients should complete imaging tests following surgery to assure a stone-free state. In addition, recurrent stone formers should complete a medical stone evaluation to identify treatable causes of their stones

Cateter uretral a permanencia: sus complicaciones / Indwelling uretheral catheter: complication

Se evaluan en el presente estudio un total de 65 pacientes a los que se le habían colocado catéteres uretrales doble "J" o pig-tail por patologías litiásicas o no. Se estudiaron sus indicaciones, control, seguimiento, sintomatología adversa, complicaciones y tratamiento. Consideramos que los catéteres doble "J" son eficaces en el posoperatorio de cirugías endourológicas, pueden ser usados como monoterapia en las litiasis obstructivas y son útiles en las uronefrosis por compresión de la vía excretora, pero que su permanencia prolongada favorece las complicaciones

Tratamiento moderno de la litiasis ureteral: estudio comparativo / Modern treatment of urethral lithiasis: a comparative study

Se comunica la experiencia del servicio de urología y nefrología del hospital General de México, en una revisión comparativa del tratamiento de la litiasis ureteral, desde que se instaló el equipo de litotripsia extracorporal, con las demás técnicas que incluyen: ureteroscopía, con o sin litotripsia electrohidráulica, litotripsia ultrasínica, canastilla Dormia, o pinza de cuerpo extraño. De igual manera, se revisan los casos de los pacientes a quienes fue necesario hacer operación abierta, debido al fracaso de alguno de los procedimientos anteriores o debido a elección de primera instancia

Uteroscopía: experiencia con 152 pacientes / Uteroscopy: experience with 152 patients

Se analizaron los expedientes clínicos de 152 pacientes atendidos en el servicio de urología y nefrología del Hospital General de México, entre el 27 de julio de 1987 y el 17 de octubre de 1991, a quienes se les realizó ureteroscopía en su mayoría por enfermedad litiásica y otros diagnósticos. Se estudiaron 161 unidades de las que 114 correspondieron al uréter inferior (70.8 por ciento), 17 unidades de uréter medio (10.5 por ciento), y 30 unidades de uréter superior (18.6 por ciento). El total de fracasos fue de 55 unidades, con éxito en 106

Ureterorrenoscopía transuretral / Rigid ureterorenoscopy

Se presenta la experiencia en ureterorrenoscopia rígida, realizada en 43 pacientes del Hospital de apoyo Cayetano Heredia. La litiasis ureteral fué la indicación más frecuente. Se resalta el hecho de la realización del procedimiento en pacientes en forma ambulatoria, evitando o disminuyendo los costos de hospitalización. El éxito se logró en el 89.7 por ciento de los pacientes con litiasis ureteral, con extracción del cálculo o destrucción de los mismos por litotricia ultrasónica. Así mismo, se hace referencia sobre sus indicaciones para fines diagnósticos, mediante la inspección visual o biopsia