Area of hydronephrosis is a useful predictive factor of impacted ureteral stones.

Ureteroscopic lithotripsy for impacted stones is challenging, but it is important to predict impacted stones preoperatively. Hydronephrosis, which is evaluated by a grading system, is often apparent in impacted stones. However, the currently used grading system is a qualitative evaluation. We, therefore, focused on a quantitative evaluation: the area of hydronephrosis. The aim of this study was to investigate whether the area of hydronephrosis could predict impacted stones more accurately than Society for Fetal Urology grade. We retrospectively identified 160 patients who underwent ureteroscopic lithotripsy for ureteral stones at our hospital between January 2014 and April 2022. Impacted stones were defined as stones fixed to the ureteral wall that could not be moved by means of ureteroscopic manipulation or water pressure. Of the 160 patients, 54 (33.8%) had impacted stones. Comparing patient characteristics, there were significant differences in stone size, ureteral wall thickness, Society for Fetal Urology grade, renal pelvic width and area of hydronephrosis (all P < 0.01). Receiver operating characteristic analysis showed that area of hydronephrosis was the more significant predictive value (area under the curve 0.781) compared with Society for Fetal Urology grade (area under the curve 0.676, P < 0.01). Multivariate analysis revealed that significant independent predictive factors of impacted stones were thicker ureteral wall thickness and larger area of hydronephrosis (both P < 0.01). The area of hydronephrosis and ureteral wall thickness were significant predictors of impacted stones in patients undergoing ureteroscopic lithotripsy for ureteral stones. These factors may be useful for selecting the treatment and preoperative settings.

Factores asociados al desarrollo de estenosis ureteral después de la ureteroscopia para cálculos ureterales impactados: estudio multicéntrico del grupo de trabajo de endourología y urolitiasis de la sección de Jóvenes Urólogos Académicos de la Asociación Europea de Urología / Factors associated with ureteral strictures following ureteroscopy for impacted ureteral stones. A multicenter study by EAU-YAU endourology and urolithiasis working party

Objetivo: Determinar la relación entre la impactación de los cálculos ureterales y la formación de estenosis ureterales y los factores asociados. Material y métodos Se analizaron retrospectivamente los registros médicos de todos los pacientes sometidos a cirugía endoscópica por cálculos ureterales impactados en 3 hospitales universitarios de Turquía, Reino Unido y España entre junio de 2019 y enero de 2022. Los parámetros examinados incluyeron los datos demográficos del paciente, lateralidad, tamaño y localización del cálculo, tiempo entre el inicio de los síntomas y la cirugía, tipo de ureteroscopia (rígida/flexible), presencia de nefrostomía o catéter doble J antes de la ureteroscopia, complicaciones intraoperatorias (avulsión/perforación), estado libre de cálculos, número de procedimientos necesarios para obtener un estado libre de cálculos y los resultados de las pruebas de imagen postoperatorias. Resultados Un total de 41 pacientes, 25 varones y 16 mujeres, de 3 instituciones fueron incluidos en el estudio. La edad media de los pacientes era de 48,2±13,5 años. La mediana del diámetro mayor de los cálculos fue de 9mm (RIC: 8mm). Catorce (34,1%) pacientes desarrollaron estenosis ureteral después de la ureteroscopia. No hubo diferencias entre los pacientes que desarrollaron estenosis ureteral y los que no la desarrollaron en cuanto a la lateralidad, la localización, la hidronefrosis y la multiplicidad de los cálculos (p=0,58, p=0,14, p=0,79 y p=0,31, respectivamente). Los pacientes que desarrollaron estenosis ureteral presentaron una tasa más elevada de derivación urinaria preoperatoria, como nefrostomía o catéter doble J (p=0,000). Conclusión La interrupción del paso de la orina por el uréter mediante derivación urinaria con nefrostomía o catéter doble J antes de la cirugía de cálculos ureterales podría favorecer la formación de estenosis ureteral en el postoperatorio. (AU)

Objective: To determine the relation between ureteral stone impaction and ureteral stricture formation and associated factors. Material and methods We retrospectively analyzed the medical records of all patients who underwent endoscopic ureteral stone surgery for impacted ureteral stone at 3 academic institutions in Turkey, United Kingdom and Spain between June 2019 and January 2022. Examined parameters included patient demographics, stone side, size and localization, time between initiation of symptoms and surgery, type of ureteroscopy (rigid/flexible), presence of nephrostomy or double-J stent prior to ureteroscopy, intraoperative complications (avulsion/perforation), stone-free status, number of procedures required for stone-free status, postoperative imaging results. Results A total of 41 patients whom 25 were male and 16 were female, from 3 institutions were included the study. The mean age of the patients was 48.2±13.5 years. The median largest diameter of the stones was 9mm (IQR: 8mm). Fourteen (34.1%) patients developed ureteral strictures following ureteroscopy. There was no difference between patients who developed ureteral strictures and patients who did not developed strictures in terms of stone laterality, stone location, hydronephrosis and multiplicity (p=0.58, p=0.14, p=0.79 and p=0.31, respectively). Patients who developed ureteral strictures had a higher rate of preoperative urinary diversion such as nephrostomy or double-J stent (p=0.000). Conclusion Interruption of urine passage through ureter via urinary diversion such as nephrostomy or double-J stent prior to ureteral stone surgery might lead ureteral stricture formation in the postoperative period. (AU)

Ureteric Calculus in a Left Complete Duplex System Masquerading as an Impacted Stone: A Case Report and Literature Review.

Ureteric calculi are common urological problems. However, the management of stone disease varies considerably with patient choice and anatomy. There are few reports about ureteral calculi in patients with unilateral complete duplex kidneys managed by ureteroscopy. We hope to increase the awareness of urologists when investigating patients with similar symptoms. We present the case of a 28-year-old man with recurring left flank pain. Non-contrast computed tomography (CT) scans of the kidney showed an impacted left vesicoureteric junction stone measuring 6 mm. Intra-operatively, a stone in the left duplex system was discovered. He was managed with ureteroscopy, laser fragmentation, and the insertion of ureteric stents. The case demonstrates the complexity of managing ureteric stones in a complete duplex kidney. We highlighted the diagnostic limitations of non-contrast scans in identifying duplex systems. It is important to consider contrast CT scans in patients with unusually persistent symptoms to outline the anatomy of the kidney and collecting systems.

Predictors of Ureteral Strictures after Retrograde Ureteroscopic Treatment of Impacted Ureteral Stones: A Systematic Literature Review.

BACKGROUND: The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as well as intervention factors, play a role in this process. In this systematic review, we aimed to determine the potential factors responsible for ureteral stricture formation in patients having impacted ureteral stones. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, we conducted systematic online research through PubMed and Web of Science without a time restriction, applying the keywords "ureteral stone", "ureteral calculus", "impacted stone", "ureteral stenosis", "ureteroscopic lithotripsy", "impacted calculus", and "ureteral strictures" singly or in combination. RESULTS: After eliminating non-eligible studies, we identified five articles on ureteral stricture formation following treatment of impacted ureteral stones. Ureteral perforation and/or mucosal damage appeared as key predictors of ureteral stricture following retrograde ureteroscopy (URS) for impacted ureteral stones. Besides ureteral perforation stone size, embedded stone fragments into the ureter during lithotripsy, failed URS, degree of hydronephrosis, nephrostomy tube or double-J stent (DJS)/ureter catheter insertion were also suggested factors leading to ureteral strictures. CONCLUSION: Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones.

Factors associated with ureteral strictures following ureteroscopy for impacted ureteral stones? A multicenter study by EAU-YAU endourology and urolithiasis working party.

OBJECTIVE: To determine the relation between ureteral stone impaction and ureteral stricture formation and associated factors. MATERIAL AND METHODS: We retrospectively analyzed the medical records of all patients who underwent endoscopic ureteral stone surgery for impacted ureteral stone at three academic institutions in Turkey, United Kingdom and Spain between June 2019 and January 2022. Examined parameters included patient demographics, stone side, size and localization, time between initiation of symptoms and surgery, type of ureteroscopy (rigid/flexible), presence of nephrostomy or double-J stent prior to URS, intraoperative complications (avulsion/perforation, stone-free status, number of procedures required for stone-free status, postoperative imaging results. RESULTS: A total of 41 patients whom 25 were male and 16 were female, from 3 institutions were included the study. The mean age of the patients was 48.2 ±â€¯13.5 years. The median largest diameter of the stones was 9 mm (IQR: 8 mm). Total 14 (34.1%) patients developed ureteral strictures following ureteroscopy. There was no difference between patients who developed ureteral strictures and patients who did not developed strictures in terms of stone laterality, stone location, hydronephrosis and multiplicity, p = 0.58, p = 0.14, p = 0.79 and p = 0.31. Patients who developed ureteral strictures had a higher rate of preoperative urinary diversion such as nephrostomy or DJS, p = 0.000. CONCLUSION: Interruption of urine passage through ureter via urinary diversion such as nephrostomy or DJS stent prior to ureteral stone surgery might lead ureteral stricture formation in the postoperative period.

Retrograde intrarenal surgery for impacted upper ureteral stone in a patient with advanced lumbar scoliosis and lower-extremity development defect: a case report.

BACKGROUND: Today, retrograde intrarenal surgery is the most preferred and very successful treatment method for upper ureteral stones that do not spontaneously pass and/or do not benefit from extracorporeal wave lithotripsy. However, perioperative complications are more common in retrograde intrarenal surgery if the stone in the ureter is impacted. Moreover, urosepsis and renal dysfunction are detected more frequently in patients with impacted stones. Impacted stones, which are a risky stone group even in patients with normal vertebral anatomy, are a more challenging situation in patients with advanced vertebral scoliosis. It is difficult to achieve an operating position in these patients. In addition, the ureteral tracing is altered, curved, and tortuous, making it more difficult for the endoscope to advance through the ureter. CASE PRESENTATION: In this case report, we present a 23-year-old Caucasian male patient with right concavity and severe scoliosis, lower-extremity developmental disorder, and urosepsis. To treat the urosepsis picture, first percutaneous nephrostomy drainage was provided and the urine was sterilized with appropriate antibiotics according to the culture/antibiogram. Then, we performed ureterolithotripsy with a flexureterorenoscope. Finally, we see that flexible ureterorenoscopic lithotripsy to the upper ureteral stone with impacted stones, which is a very challenging operation even in patients with normal vertebrae, could be successfully performed in our patient with advanced scoliosis deformity. CONCLUSION: High stone-free and low complication rates can be obtained with flexible ureterorenoscopic retrograde intrarenal surgery in medium-sized impacted upper ureteral stones in patients with advanced scoliosis.

Laparoscopic lithotripsy and lithotomy of impacted stone at the terminal end of the common bile duct using a laparotomy biliary lithotomy spoon: A case report.

INTRODUCTION AND IMPORTANCE: Endoscopic intervention is considered first-line therapy for common bile duct (CBD) stones, in recent times. However, surgically altered anatomy and consequent inaccessibility of the duodenal papilla necessitate surgery in some patients. CASE PRESENTATION: A 61-year-old woman presented with fever and right subcostal pain. She underwent total gastrectomy and Roux-en-Y reconstruction for gastric ulcer, 4 years prior to presentation. Based on the clinical findings, she was diagnosed with acute obstructive cholangitis secondary to a CBD stone. Endoscopic retrograde biliary drainage was attempted; however, the duodenal papilla was endoscopically inaccessible owing to the previous Roux-en-Y reconstruction, and we performed percutaneous transhepatic gallbladder drainage (PTGBD). She underwent laparoscopic cholecystectomy and choledocholithotomy, 6 days after the PTGBD. Choledocholithotomy was attempted using basket forceps under choledochoscopic guidance; however, this procedure was unsuccessful, and we performed laparoscopic choledocholithotomy using a laparotomy biliary lithotomy spoon. CLINICAL DISCUSSION: Usually, laparoscopic cholecystectomy concomitant with CBD exploration is performed in patients with an endoscopically inaccessible duodenal papilla. However, an inadequately opened basket may not capture large impacted stones at the duodenal end of the CBD. Intraductal shock wave lithotripsy (electrohydraulic or laser lithotripsy) is considered in such cases; however, the specialized instruments required for this procedure are unavailable at all centers. Laparoscopic choledocholithotomy using a laparotomy biliary lithotomy spoon may be useful to overcome this surgically challenging situation. CONCLUSION: A laparotomy biliary lithotomy spoon is a simple, user-friendly, and economical device that may be useful for laparoscopic lithotripsy and lithotomy of impacted stones.

The impact of preoperative percutaneous nephrostomy as a treatment strategy before flexible ureteroscopy for impacted upper ureteral stones with hydronephrosis.

BACKGROUND: The treatment of impacted upper ureteral stones with hydronephrosis remains a challenge for urologists. The current study aimed to evaluate the impact of preoperative percutaneous nephrostomy (PNS) as a treatment strategy before flexible ureteroscopy (f-URS) of asymptomatic impacted upper ureteral stones with hydronephrosis. METHODS: This multicenter retrospective study included patients who underwent PNS (group A, n=61) and those who did not (group B, n=75) before f-URS for asymptomatic impacted upper ureteral stones with hydronephrosis. Impacted ureteral stones are defined as those that remain in one position for >2 months. Operative outcomes, including stone-free rate, operation time, postoperative hospital days, and complication rate, were evaluated. RESULTS: There were no significant differences in age, sex, and stone size between the two groups except in the grade of hydronephrosis, with group A having more cases of advanced hydronephrosis than group B. The stone-free rate was significantly higher in group A than in group B [95% vs. 77% (P=0.004)]. However, there were no significant differences between the groups in operation time [55 vs. 55 min (P=0.84)], postoperative fever [5% vs. 5% (P=1.00)], and postoperative hospital days [2 vs. 2 days (P=0.44)]. In group A, preoperative PNS placement was performed 4 days before f-URS, and the PNS was removed postoperatively on the same day of the f-URS. Additionally, subgroup analysis was performed in cases of grade 2 and 3 hydronephrosis. A total of 110 patients, 60 who underwent f-URS with PNS and 50 who underwent f-URS without PNS, were included. The stone-free rate was significantly higher in f-URS with PNS than in f-URS without PNS [95% vs. 76% (P=0.005)]. However, no significant differences were found between the groups in operation time, ureteral injury, postoperative fever, and postoperative hospital days. CONCLUSIONS: At grade 2 or 3 hydronephrosis, preoperative PNS as a treatment strategy for a few days prior to f-URS for impacted upper ureteral stones improved the stone-free rate without increasing the operation time and postoperative length of hospital stay.

Development and validation of a preoperative nomogram for predicting patients with impacted ureteral stone: a retrospective analysis.

BACKGROUND: To develop and validate a practical nomogram for predicting the probability of patients with impacted ureteral stone. METHODS: Between June 2020 to March 2021, 214 single ureteral stones received ureteroscopy lithotripsy (URSL) were selected in development group. While 82 single ureteral stones received URSL between April 2021 to May 2021 were included in validation group. Independent factors for predicting impacted ureteral stone were screened by univariate and multivariate logistic regression analysis. The relationship between preoperative factors and stone impaction was modeled according to the regression coefficients. Discrimination and calibration were estimated by area under the receiver operating characteristic (AUROC) curve and calibration curve respectively. Clinical usefulness of the nomogram was evaluated by decision curve analysis. RESULTS: Age, ipsilateral stone treatment history, hydronephrosis and maximum ureteral wall thickness (UWTmax) at the portion of stone were identified as independent predictors for impacted stone. The AUROC curve of development and validation group were 0.915 and 0.882 respectively. Calibration curve of two groups showed strong concordance between the predicted and actual probabilities. Decision curve analysis showed that the predictive nomogram had a superior net benefit than UWTmax for all examined probabilities. CONCLUSIONS: We developed and validated an individualized model to predict impacted ureteral stone prior to surgery. Through this prediction model, urologists can select an optimal treatment method and decrease intraoperative and postoperative complications for patients with impacted ureteral calculus.

Screening of clinical indicators for evaluation of incarcerated stone before operation / 中华泌尿外科杂志

Objective To investigate the clinical indicators which could be used to differentiate incarcerated stones from unincarcerated stones by comparing clinical characteristics of patients.Methods 96 patients who were diagnosed as ureteral stones treated by ureteroscopic lithotripsy (URSL) from June 2017 to November 2017 were selected in the study.Clinical characteristics of patients were collected.The total study consisted of 62 male and 34 female patients.The patients' age ranged from 24 to 78 years old and average age was (54.5 ± 12.7) years old.There were 35 patients were diagnosed as ureteral stones with hypertension,9 patients with diabetes,85 patients with hydronephrosis,respectively.The number of patients,whose stone located in upper ureters,middle ureters and lower ureters were 49,19,28,respectively.The average of maximum stone diameter,maximum cross-sectional area of the stone,stone volume,hounsfield units of stone and maximum ureteral wall thickness (UWTmax) at the stone site were (7.75 ± 2.68) mm,(36.12 ± 24.43) mm2,(304.06 ± 303.39) mm3,(755.75 ± 318.05) HU,and (3.18 ± 1.13) mm,respectively.Percussion tenderness over kidney region were positive in 11 cases,weak positive in 64 cases and negative in 21 cases,respectively.Stone-free rate after operation were 93.8％.Patients were divided into two groups,incarcerated or unincarcerated,and statistical differences between clinical characteristics of the two groups were analyzed by univariate analysis.The differences were further compared by multivariate logistic regression analysis to find independent predictors of impacted stones.The ROC curve was used to find the optimal UWT for diagnosis of impacted stone.The accuracy of this value was evaluated and patients were grouped by this value to compare the differences between groups.Results The operation and follow-up were successfully performed in all patients.Univariate analysis showed there were no statistical significance differences in gender [(24 males and 16 females)vs.(38 males and 18 females)],age [(53.4 ± 12.3) years vs.(48.7 ± 12.7) years],previous history of diabetes (4 cases vs.5 cases) and stone location [(19 upper stones,9 middle stones,12 lower stones) vs.(30 upper stones,10 middle stones,16 lower stones)],between the two groups (P ＞ 0.05).Among the clinical characteristics of patients in incarcerated and unincarcerated groups,UWTmax were (4.15 ± 0.94) mm and (2.58 ± 0.76) mm,previous history of hypertension were 20 cases and 15 cases,ipsilateral URSL history were 14 cases and 10 cases,hounsfield units of stone were (847.66 ± 282.39) HU and (698.65 ± 325.50) HU,hydronephrosis were 40 cases and 50 cases,maximum stone diameter were (8.67 ± 2.28)mm and (7.17 ± 2.75)mm,maximum cross-sectional area of the stone were (43.83 ± 23.65) mm2 and (31.14 ± 23.64) mm2,stone volume were (386.20 ± 296.60) mm3 and (253.04 ± 296.29) mm3,percussion tenderness over kidney region were positive in 8 cases(20.0％),weak positive in 27 cases,negative in 5 cases and positive in 3 cases,weak positive in 37 cases,negative in 16 cases,respectively.The difference was statistically significant (P ＜ 0.05).Multivariate logistic regression analysis showed UWTmax (OR =10.40,P ＜ 0.001) at the stone site was significantly correlated with impacted ureteral stones and it was an independent predictor of impacted stones.ROC curve analysis showed that the optimal cut-off value of UWTmax was 3.26 mm.The sensitivity of the value to predict impacted stone is 82.5％ and the specificity is 87.5％.Depending on the cut off value of 3.26 mm,cases were divided into two groups,40 cases were in high UWTmax (≥3.26 mm)group and 56 cases were in low UWTmax (＜ 3.26 mm)group.Higher UWTmax was accompanied with a higher incidence of ureteral edema[77.5％ (31/40) vs.32.1％ (18/56)],polyps [30.0％ (12/40) vs.7.1％ (4/56)],strictures[37.5％ (15/40)vs.12.5％ (7/56)] and a lower stone-free rate[87.5％ (35/40) vs.98.2％ (55/56)].The difference was statistically significant (P ＜ 0.05).Conclusions UWTmax can be used to differentiate impacted stones from unimpacted stones before surgery.The patients with Higher UWTmax (≥3.26 mm) was accompanied with a higher incidence of stone impacted,ureteral edema,polyps,and strictures,and a lower rate of stone clearance.

Evaluation with Decision Trees of Efficacy and Safety of Semirigid Ureteroscopy in the Treatment of Proximal Ureteral Calculi.

PURPOSE: The decision on the choice of proximal ureteral stone therapy depends on many factors, and sometimes urologists have difficulty in choosing the treatment option. This study is aimed at evaluating the factors affecting the success of semirigid ureterorenoscopy (URS) using the "decision tree" method. MATERIALS AND METHODS: From January 2005 to November 2015, the data of consecutive patients treated for proximal ureteral stone were retrospectively analyzed. A total of 920 patients with proximal ureteral stone treated with semirigid URS were included in the study. All statistically significant attributes were tested using the decision tree method. RESULTS: The model created using decision tree had a sensitivity of 0.993 and an accuracy of 0.857. While URS treatment was successful in 752 patients (81.7%), it was unsuccessful in 168 patients (18.3%). According to the decision tree method, the most important factor affecting the success of URS is whether the stone is impacted to the ureteral wall. The second most important factor affecting treatment was intramural stricture requiring dilatation if the stone is impacted, and the size of the stone if not impacted. CONCLUSIONS: Our study suggests that the impacted stone, intramural stricture requiring dilatation and stone size may have a significant effect on the success rate of semirigid URS for proximal ureteral stone. Further studies with population-based and longitudinal design should be conducted to confirm this finding.

Two-year-old girl with impacted ureteral stone successfully treated with a single session of combined percutaneous nephrostomy and ureteroscopy.

Impacted stones frequently cause changes in the ureter, including edema of the ureteral wall, stone embedding in the ureteral mucosa or ureteral bending, which often preclude spontaneous passing of the stone and increase the risk of complications during surgery. When stone impaction is suspected preoperatively, management should be adapted accordingly. However, surgical treatment strategies remain controversial in pediatric patients because of the scarcity of cases reported. We describe the case of a 2-year-old girl with a right impacted ureteral stone who presented with gross hematuria and pyuria, but no metabolic risk factors or hematological abnormalities. Ureteroscopy was carried out in the presence of a percutaneous nephrostomy catheter. At the 7-month follow up, hydronephrosis had improved from grade 3 to grade 1, and the ureter was free from residual or recurrent stones. No complications were noted. We believe that percutaneous nephrostomy before the lithotripsy facilitates treatment for impacted stones in pediatric patients.

Retroperitoneal laparoscopic ureterolithotomy in comparison with ureteroscopic lithotripsy in the management of impacted upper ureteral stones larger than 12 mm.

OBJECTIVE: To compare the results of ureteroscopic lithotripsy (URSL) with retroperitoneal laparoscopic ureterolithotomy (RPLU) as two minimally invasive techniques in the management of proximal ureteral stones larger than 12 mm. PATIENTS AND METHODS: From January 2009 to October 2013, patients with impacted unilateral upper ureteral stones larger than 12 mm were enrolled including 182 males and 93 females with a medium age of 40 years (22-72 years). Patients were randomized to receive URSL (139 cases) with semirigid ureteroscope or RPLU (136 cases). RESULTS: Stone size was similar in RPLU and URSL groups (13.8 ± 1.9 vs 13.6 ± 1.4 mm, P = 0.312). Operating time and hospitalizing days in URSL group were significantly shorter than those in RPLU group (P < 0.001), whereas stone clearance rate was significantly higher in RPLU group (97.1 vs 89.9 %, P = 0.017). Ureteral strictures happened higher in URSL group (5 patients, 3.6 %) than RPLU group (2 patients, 1.5 %) with no statistical significance, while the strictures requiring surgical intervention were significantly higher in URSL group (4 cases) (2.9 vs 0 %, P = 0.046). CONCLUSION: RPLU could provide better stone clearance rate than semirigid URSL for upper ureteral impacted stones larger than 12 mm. It may also reduce the chance of surgical intervention for postoperative ureteral stricture.

Management of impacted proximal ureteral stone: Extracorporeal shock wave lithotripsy versus ureteroscopy with holmium: YAG laser lithotripsy.

OBJECTIVE: PROSPECTIVE EVALUATION OF THE EFFICACY AND SAFETY OF THE EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (SWL) AND URETEROSCOPY WITH HOLMIUM: YAG laser lithotripsy (URSL) as a primary treatment for impacted stone in the proximal ureter. PATIENTS AND METHODS: A total of 82 patients with a single impacted stone in the proximal ureter were included in the study. Patients were allocated into two groups according to patient preference for either procedure. The first group included 37 patients who were treated by SWL and the second group included 45 patients treated by URSL. The preoperative data and treatment outcomes of both procedures were compared and analyzed. RESULTS: There was no difference as regards to patient and stone characters between the two groups. There was significantly higher mean session number and re-treatment rate in the SWL group in comparison to URSL group (1.5 ± 0.8 vs. 1.02 ± 0.15 session, and 43.2% vs. 2.2%, respectively). At one month, the stone-free rate of the URSL group was statistically significantly higher than that of the SWL group (80% vs. 67.6%, respectively). The stone-free rate at three months was still higher in the URSL group, but without statistically significant difference (80.2% vs. 78.4%, respectively). There was no statistically significant difference in the rate of complications between the SWL and URSL (24.3% vs. 15.6%, respectively). CONCLUSION: Both procedures can be used effectively and safely as a primary treatment for impacted stone in the proximal ureter; however, the URSL has a significantly higher initial stone-free rate and lower re-treatment rate.

Ictericia obstructiva secundaria a cálculo pancreático impactado en la papila / Obstructive jaundice secondary to impacted pancreatic calculus in the papilla

Los cálculos biliares impactados en la papila son un hallazgo frecuente. Por el contrario, los cálculos pancreáticos que destruyen la papila son muy raros. Hay pocos informes sobre esta complicación de la pancreatitis crónica en la literatura. Aquí informamos otro de estos casos, único en nuestra experiencia.

Bile duct stones obstructing the papilla are a quite common finding. On the other hand a pancreatic stone obstructing the papilla is quite rare. There are few reports of this complication of chronic pancreatitis in the literature. Here we inform of another unique case.

An Impacted Distal Common Bile Duct Stone Mimicking a Tumor: An Unusual Manifestation of Gallstone Disease / 대한소화기내시경학회지

Patients with bile duct stones usually present with biliary pain, obstructive jaundice, ascending cholangitis, or pancreatitis. When endoscopic retrograde cholangiopancreatography (ERCP) is performed, bile duct stones are usually movable and thus easily detected. If a stone in the bile duct presents unusually, it may pose some diagnostic challenges. Recently, we experienced a case of an impacted distal common bile duct (CBD) stone mimicking a tumor which resulted in performing a pylorus-preserving pancreaticoduodenectomy in an asymptomatic 56-year-old man. On ERCP, an obstructing distal CBD lesion did not move even by doing brush cytology. Moreover, the result of brush cytology was positive for atypical cells. A major resective surgery performed after recovery from severe post-ERCP pancreatitis confirmed the diagnosis. Interestingly, this stone caused erosion with acute and chronic inflammation and fibrosis containing foci of mild epithelial dysplasia. We herein report an unusual manifestation of gallstone disease with a review of the literature.

An Impacted Pancreatic Stone at the Orifice of the Minor Papilla Causing a Bout of Acute Pancreatitis in a Patient with Pancreas Divisum / 대한소화기내시경학회지

Pancreas divisum is the most common congenital anomaly of the pancreas. Whether pancreas divisum is the cause of chronic abdominal pain, acute pancreatitis, or chronic pancreatitis is a matter of controversy yet. We recently experienced a case of acute pancreatitis due to an impacted stone at the orifice of the minor papilla in a 58 year-old man with pancreas divisum who showed clear radiologic evidences of dorsal chronic pancreatitis. The bout of acute pancreatitis recovered rapidly after endoscopic treatment (minor papilla sphincterotomy, stone removal, and endoscopic nasopancreatic drainage). We herein report an unusual manifestation of pancreas divisum in which endoscopic treatment was effective.