A Prospective Evaluation of the Association of Ureteral Wall Thickness With Intraoperative Stone Impaction in Ureteroscopy.

Background and objective In this study, we aimed to analyze the association of ureteral wall thickness (UWT) measured on non-contrast CT (NCCT) with stone impaction as found in ureteroscopy (URS). Materials and methods We analyzed 43 patients who underwent URS and pneumatic/laser lithotripsy for ureteric stones from May to November 2022. The UWT was measured by an experienced radiologist on NCCT. Clinical predictors of the impacted stone were calculated by univariate and multivariate regression analysis. The receiver operating characteristic (ROC) curve was calculated for the UWT cutoff to apply it for impaction with different parameters. We also evaluated the association of intra- and postoperative parameters of the two groups with UWT. Results Out of the 43 patients with stones, 26 (60.46%) patients had impacted stones. Univariate analysis was used to analyze the site (left-sided stone impacted more commonly), stone size, stone density [Hounsfield unit (HU)], hydronephrosis, UWT, and duration between initial presentation and surgery, and multivariate analysis was utilized to assess stone density, as well as UWT's association with impacted stones. The ROC curve showed a cutoff of 3.5 mm for UWT with an accuracy of 0.83. High UWT (≥3.5 mm) was associated with a significantly lower stone-free rate, more complications, and mean operative time as compared to low UWT (<3.5 mm) (p<0.05). Conclusion Based on our findings, high UWT is associated with high rates of impacted stones and a lower stone-free rate when compared to low UWT.

Translation and Validation of the Ureteral Stent Symptoms Questionnaire in Urdu.

Introduction In endourology, ureteric stenting is a common procedure, and stent placement is not without adverse health consequences. A ureteric stent symptoms questionnaire (USSQ) was devised to objectively evaluate the symptoms related to it. The original questionnaire is in English and translated into various languages worldwide. We translated the questionnaire into Urdu and validated it in an Urdu-speaking population with a stent in situ. Materials and methods The English version of USSQ was translated and back-translated by experts in both languages. Content validity was checked by sending Urdu version to five experts, and their scores were used to calculate the content validity index. The final version was filled by patients with stents on three different occasions, two with stents in situ at one and two weeks post stent placement, and a third time two weeks after stent removal. Discriminant validity was checked by filling of USSQ by 64 healthy individuals. Statistical analysis was done with mean and standard deviation, Cronbach's alpha, Spearman's coefficient, and paired sample t-test. Results A total of 64 patients filled the complete questionnaire at all times with mean age of 35.31 ± 8.853. All subdomains of USSQ have significant drop in scores with stent in situ in comparison to post stent removal. Reliability was checked by Cronbach's alpha in all subdomains (71.5-91.1) and test-retest reliability by Spearman's coefficient (80.5-94.7). Symptoms change in stent in situ with post stent removal checked with paired sample t-test with a p-value of <0.005 in all domains, except body pain. Discriminant validity was checked with healthy controls, and a p-value of <0.005 was found in all subdomains of USSQ, except pain.  Conclusion The Urdu version of the USSQ is a reliable and valid instrument that can be used in clinical practice and future research in an Urdu-speaking population.

Access and Fluoroscopy Time Difference in Patients Undergoing Prone Percutaneous Nephrolithotomy (PCNL) With Ureteric Catheter Placement in Supine Versus Lithotomy Position.

OBJECTIVE: To compare the operative and fluoroscopy time in two different methods of ureteral stent insertion before prone percutaneous nephrolithotomy (PCNL). MATERIALS AND METHOD: Over 12 months, 124 patients with urolithiasis who went through prone PCNL were included in our study. All the patients had kidney stones and were divided into two groups based on the method of ureteral catheter insertion. This was done with the help of flexible or rigid cystoscopy in to group A and group B, respectively. Both groups had an equal number of patients, i.e., 62. The main outcome variables assessed were access time (from intubation to placement of access sheath) and fluoroscopy time during access. RESULTS: The categorical variables (age, gender, site of the stone) between the two groups were comparable. The access time in groups A and B were 48±4.30 and 77±10 minutes, respectively. The fluoroscopy times in groups A and B were 52±14.63 and 116±47.77 seconds, respectively. A statistically significant difference (p-value < 0.05) was observed for both the access and fluoroscopy time. None of the patients in either of the groups had a misplaced ureteral catheter requiring repositioning. CONCLUSION: Flexible cystoscope-assisted insertion of ureteral catheter prior to PCNL significantly reduces operative time, fluoroscopy time, and consequently radiation exposure during PCNL.