Search

OBJECTIVES: To develop a nomogram that could predict spontaneous stone passage (SSP) in patients presenting with acute ureteric colic who are suitable for conservative management. SUBJECT/PATIENTS: A 2517 patient dataset was utilised from an international multi-centre cohort study (MIMIC, A Multi-centre Cohort Study Evaluating the role of Inflammatory Markers In Patients Presenting with Acute Ureteric Colic) of patients presenting with acute ureteric colic across 71 secondary care hospitals in the United Kingdom, Ireland, Australia, and New Zealand. Inclusion criteria mandated a non-contrast CT-KUB. METHODS: SSP was defined as the 'absence of the need for intervention'. The model was developed using logistic regression and backwards selection (to achieve lowest AIC) in a subset from 2009-2015 (n=1728) and temporally validated on a subset from 2016-2017 (n=789). RESULTS: Of the 2517 patients, 1874 had SSP (74.5%). Mean age (±[SD]) was 47 (±14.7) years and 1892 were male (75.2%). At the end of the modelling process, gender: male (OR 0.8, 95%CI 0.64-1.01, p=0.07), neutrophil count (OR 1.03, 95%CI 1.00-1.06, p = 0.08), hydronephrosis (OR 0.79, 95%CI 0.59-1.05, p=0.1), hydroureter (OR 1.3, 95%CI 0.97-1.75, p =0.08), stone size >5-7mm (OR 0.2, 95%CI 0.16-0.25, p7mm (OR 0.11, 95%CI 0.08-0.15, p

OBJECTIVE To determine the diagnostic accuracy of ultra-low-dose computed tomography (ULDCT) compared with standard-dose CT (SDCT) in the evaluation of patients with clinically suspected renal colic, in addition to secondary features (hydroureteronephrosis, perinephric stranding) and additional pathological entities (renal masses). PATIENTS AND METHODS A prospective, comparative cohort study was conducted amongst patients presenting to the emergency department with signs and symptoms suggestive of renal or ureteric colic. Patients underwent both SDCT and ULDCT. Single-blinded review of the image sets was performed independently by three board-certified radiologists. RESULTS Among 21 patients, the effective radiation dose was lower for ULDCT [mean (SD) 1.02 (0.16) mSv] than SDCT [mean (SD) 4.97 (2.02) mSv]. Renal and/or ureteric calculi were detected in 57.1% (12/21) of patients. There were no significant differences in calculus detection and size estimation between ULDCT and SDCT. A higher concordance was observed for ureteric calculi (75%) than renal calculi (38%), mostly due to greater detection of calculi of

OBJECTIVES To evaluate the clinical, fiscal and environmental impact of a specialist-led acute ureteric colic virtual clinic (VC) pathway. PATIENTS AND METHODS All patients with uncomplicated acute ureteric colic, referred to a single tertiary centre, were prospectively entered into the study over a 4-year period (January 2015-December 2018). Inclusion criteria were: low-dose non-contrast computed tomography of kidneys, ureters and bladder; white blood cell count

OBJECTIVE: To perform a systematic review to identify the clinical, fiscal and environmental evidence on the use of urological telehealth and/or virtual clinic strategies. Our secondary aim was to highlight research gaps in this rapidly evolving field. METHODS: Our PROSPERO registered (CRD42019151946) systematic search of Embase, Medline and Cochrane Review Database was performed for original research articles pertaining to adult urology telehealth or virtual clinic strategies. Risk of bias (RoB) assessment performed according to Cochrane 2.0 RoB or Joanna Briggs Institute Checklist for non-randomised studies. RESULTS: 5,813 participants met inclusion from 18 original articles (2 randomised controlled trials; 10 prospective; 6 retrospective). Urology sub-specialities: Uro-oncology (n=6), General urology (n=8), Endo-urology (n=2), and Lower urinary tract symptoms and/or incontinence (n=2). Across all sub-specialties, prospective studies utilising VC reported: primary median VC discharge rate of 16.6% (IQR 14.7%-29.8%) and primary median face-to-face (FTF) clinic referral rate of 32.4% (IQR 15.5%-53.3%). Further, direct cost analysis demonstrated a median annual cost-savings of £56,232 (IQR £46,260-£61,116). Grade II and IIIb complications were reported in two acute ureteric colic studies, with a rate of 0.20% (3/1,534) and 0.13% (2/1,534), respectively. Annual carbon footprint avoided ranged from 0.7 to 4.35 metric tonnes of CO2 emissions, depending on mode of transport utilised. Patient satisfaction was inconsistently reported, and assessments lacked prospective evaluation using validated questionnaires. CONCLUSION: Virtual urology clinics are a promising new platform which can offer clinical, financial and environmental benefits to support an increasing urological referral burden. Further prospective evidence is required across urological subspecialties to confirm equivalency and safety against traditional face-to-face assessment.

Background It has been reported that three criteria (size of calculus ≥6 mm, visual analogue scale pain score at discharge ≥2 cm and location above mid-ureter; the Papa criteria) were sensitive for predicting patients who require intervention (surgery or lithotripsy) within 28 days of index emergency department (ED) visit for ureteric colic. It was suggested that absence of these criteria identified a group for whom early follow-up may not be needed. No validation has been reported. We aimed to validate these criteria. Methods Retrospective cohort study of patients with clinical presentation of ureteric colic and radiologically proven renal tract stones. Data collected included demographics, clinical features, features of the stone, imaging results and 28-day outcome. Outcome of interest was performance of the Papa criteria for prediction of urological intervention by clinical performance analysis. We also undertook a post hoc analysis to identify predictors of urological intervention for the group overall and for the subgroup discharged from ED. Results Two hundred and twenty-four patients were studied (median age 49, 79% male) with 75 (33%) requiring urological intervention within 28 days. The presence of any of the Papa criteria had sensitivity for urological intervention of 83.9% (95% confidence interval (CI) 71.2–91.9%) with specificity of 47.7% (95% CI 38.9–56.6%), positive predictive value of 40.9% (95% CI 31.9–50.4%) and negative predictive value of 87.3% (95% CI 76.8–93.7%). Nine patients with no Papa criteria had intervention: 12.7% (95% CI 6.8–22.4%). Conclusion The Papa criteria are not sufficiently accurate to determine which patients require intervention or a subgroup who do not need specialist urological follow-up.

Objective To analyse the outcomes of emergency ureteroscopy (URS) cases performed in Auckland City Hospital. Methods We conducted a retrospective review of all emergency URS procedures performed at Auckland City Hospital between 1 January 2010 and 31 December 2011. Data on patients, stones and procedures were collected and analysed. Emergency URS failure was defined as fragments >3 mm or the need for a repeat procedure. Results A total of 499 URS procedures were identified. Of these 394 (79%) were emergency procedures. The mean (sd; range) patient age was 48 (16; 13–88) years. In all, 83% of emergency URS cases had an American Society of Anesthesiologists (ASA) score of 1 or 2, 25% of stones were >9 mm, with a mean (sd) size of 8 (4) mm, and 285 procedures (72%) were successful. These patients were younger (47 vs 51 years), were more likely to have an ASA score of 1 (103 patients in the successful treatment group vs 26 in the failed treatment group), had smaller stones (7 vs 9 mm) and were more likely to have distal stones (P < 0.05). A total of 20 complications (5%) were recorded including six false passages and three mucosal injuries, one of which required radiological intervention, and 50 patients (13%) re-presented, for pain (76%), bleeding (10%) or infection (14%). Conclusion We showed that emergency URS is a feasible approach for the routine management of acute ureteric colic with a low complications rate. A subgroup of younger, healthier patients may benefit the most from the procedure.

The first of the two articles in this section examines the dynamic rates of arterial delivery and renal drainage in patients whose renogram showed a Homsy sign, using optimised computer compartmental modelling. The author found that the standard model was unlikely to be correct, and that the Homsy sign was probably an artefact seen in patients with impeded urinary drainage. In the second, the authors from Budapest studied the effect of drotaverine in patients with ureteric colic; it was of significant help in this condition. OBJECTIVE To estimate the dynamic rates of arterial delivery and renal drainage in renograms with the Homsy sign, using optimized computed compartmental modelling. METHODS Eleven F−15 renograms and one F+15 renogram (using 99mTc-mercaptoacetyltriglycine) with the Homsy sign were studied, with 26 controls. Compartmental models were constructed for each renogram using components (blood, renal, bladder) linked by variables (arterial rate, drainage rate). Each model was optimized using the Marquadt least-squares method to numerical data from the time-activity curves (TACs). The model renal component at sample points along the TAC was minimized and the corresponding drainage rates calculated. RESULTS The models were optimized, with a mean (range) r2 of 0.811 (0.68–0.88). There were continuous low drainage rates for all type 4 renograms, with no quadrupling of the flow rate, as predicted by the standard model. CONCLUSION The standard model is unlikely to be correct and the Homsy sign is probably an artefact seen in patients with impeded urinary drainage. Computer modelling of individual renograms is feasible and can provide useful insights into the pathophysiology of renal uptake and drainage.

Objectives: 1. To investigate the diagnostic accuracy of urinalysis and the plain abdominal radiograph in predicting positive intravenous pyelography for patients with a history and examination suggestive of ureteric colic. 2. To examine the disposition of patients presenting to the emergency department with ureteric colic. Methods: A retrospective cohort study set in a tertiary referral hospital emergency department over a 12-month period was conducted. Three hundred and eighteen patients who presented with a provisional diagnosis of ureteric colic and had intravenous pyelography were identified from radiology department logs and emergency department discharge International Classification of Disease-9 codes.Results: Three hundred and eighteen patients were identified. Sixty-nine per cent had positive intravenous pyelography. Sensitivity and specificity of: urinalysis were 93% and 41%; abdominal X-ray, 57% and 83%; and urinalysis plus abdominal X-ray, 99% and 36%, respectively. Seventy-seven per cent were admitted to the emergency department observation ward. Twenty-seven per cent were subsequently admitted under the hospital's urology service. Conclusions:Sex, haematuria and the presence of a calculus on abdominal X-ray were all significant predictors of positive intravenous pyelography. Haematuria was sensitive but not specific for positive intravenous pyelography. The addition of the abdominal X-ray marginally improves the diagnostic accuracy.

Background: Electrohydraulic lithotripsy (EHL) has been available for endoscopic treatment of urinary calculi since 1960, but the large probe size and concerns regarding safety had previously restricted its use to the treatment of bladder calculi. However, recent refinements have made it particularly suitable for the treatment of ureteric calculi. Methods: The authors report their initial experience using EHL in conjunction with mini-ureteroscopy in the treatment of 94 ureteric calculi in 89 patients. The size of the calculi ranged from 3 to 19 mm in diameter, with a mean of 8.2 mm. The mean operating time was 29 min, ranging from 10 to 120 min. Results: A complete fragmentation rate of 91.5% of the calculi was achieved. There were no major complications and a low incidence of minor complications: haematuria (2.2%), urinary tract infection (3.4%) and postoperative ureteric colic (2.2%). There were four cases of minor ureteric perforations (4.5%); all were successfully treated using conservative measures. Conclusions: It is concluded that EHL is a safe and effective method of treating ureteric calculi.

Summary A clinicopathologic correlation of 2 patients with crossed renal ectopia presenting with ureteric colic and 4 cases collected from the literature is presented. The correlation serves to reaffirm the theory of ureteral and not renal, migration as the primary aberration resulting in this defect.

A retrospective study of 1097 male in-patients with ureteric colic was conducted to try and define the aetiological effect of climate on the disease. The overall monthly incidence for the study period of 10 years was found, on statistical analysis to correlate with ambient temperature thus: (1) directly with the mean temperature of the preceding month, (2) directly with the difference between mean maximum and mean minimum temperatures of the same month, and (3) inversely with the mean maximum temperature of the same month. The correlation was interpreted on the basis that hot ambient temperatures promoted stone generation whereas cold ones promoted stone descent through cold-induced diuresis. This trend, among its other implications, could pinpoint the reason for the increase in nephrolithiasis with industralisation.

Forty-six ureteroscopies were carried out over a 12-month period. A simple technique is described. The desired level was reached in 72% of cases and the pre-operative objective achieved in 60% of cases overall. Fifty per cent of all ureteric stones were safely retrieved by ureteroscopy. The instrument was used to establish a diagnosis of upper urinary tract abnormality in 16 of 23 cases. The overall complication rate was low, most problems relating to short-lived ureteric colic (23%) which was seen mainly after stone manipulation. Transurethral ureteroscopy is a safe procedure with a number of diagnostic and therapeutic possibilities.