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Key Clinical Message: Although anatomical and vascular abnormalities of the horseshoe kidney might be challenging, complete preoperative imaging evaluations and accurate organ‐sparing surgical planning can lead to much lower complications. Horseshoe kidney (HK) is one of the most common renal fusion anomalies. Renal carcinoids are rarely reported in HK patients. Here, we described a rare case of advanced right renal cell carcinoma (RCC) along with proximal left ureter stone in a 41‐year‐old man who presented with a complaint of turbid urine. Early blood tests revealed a blood urea nitrogen of 44 mg/dL and serum creatinine of 1.35 mg/dL. The urine analysis showed microscopic hematuria (6–8 RBCs) and few calcium oxalate crystals. The imaging evaluations revealed an HK anomaly with a solid mass on the right side and a 4 mm stone in the proximal left ureter. The findings suggested RCC which was confirmed by histopathology examination. Consequently, the patient was scheduled for an organ‐preserving open surgery of a right kidney tumor with concomitant left ureterolithotomy. The 16‐month follow‐up showed no urological complications, metastasis, or tumor proliferation. Although the anatomical and vascular abnormalities of HK might be challenging, organ‐sparing surgical treatment should be considered in feasibly resectable tumors. Complete preoperative imaging evaluations to identify the characteristics of HK, as well as accurate surgical planning, can lead to much lower complications. [ABSTRACT FROM AUTHOR]

Background: Limited information is available regarding the outcome of medical management (MM) of benign ureteral obstruction in cats (BUO). Hypothesis: Describe clinical characteristics and outcome of MM of BUO. Animals: Seventy‐two client‐owned cats with 103 obstructed kidneys. Methods: Medical records of cats diagnosed with BUO between 2010 and 2021 that received >72 hours of MM were retrospectively reviewed. Clinical data, treatment, and outcome were reviewed. Outcome was classified as success, partial success, or failure based on ultrasound findings. Factors associated with outcome were assessed. Results: Seventy‐two cats with 103 obstructed kidneys were enrolled. The causes of obstruction were uroliths in 73% (75/103), strictures in 13.5% (14/103), and pyonephrosis in 13.5% (14/103) of affected kidneys. Median serum creatinine concentration at presentation was 4.01 mg/dL (range, 1.30‐21.3 mg/dL). Outcome after MM was considered a success in 30% (31/103), partial success in 13% (13/103), and failure in 57% (59/103) of kidneys. Success was reported in 23% (17/75) of kidneys with uroliths, 50% (7/14) with pyonephrosis, and 50% (7/14) with strictures. Median time to a successful outcome was 16 days (range, 3‐115 days). Distal and smaller uroliths (median length, 1.85 mm) were significantly associated with success (P =.05 and P =.01, respectively). Median survival times were 1188 days (range, 60‐1700 days), 518 days (range, 7‐1812 days), and 234 days (range, 4‐3494 days) for success, partial success, and failure, respectively. Conclusions and Clinical Importance: We found a higher success rate for MM of BUO than previously reported. Smaller distal uroliths (<1‐2 mm) were more likely to pass. [ABSTRACT FROM AUTHOR]

Objectives: Obstructing ureteral stones complicated by urinary tract infection are urologic emergencies that require prompt decompression. We explore the association of pregnancy with rates of and delays in decompression in a cohort of women of reproductive age. Methods: Using the National Inpatient Sample from 2010 to 2015, a cross‐sectional, descriptive analysis of women of reproductive age (15 to 44 years old) diagnosed with obstructing ureteral stones and urinary tract infection was performed and stratified by pregnancy status. Survey‐weighted regression models were used to assess the association of pregnancy on decompression, delays in decompression, and hospital length of stay. Additional exploratory analyses on the association of timing and type of decompression with maternal‐fetal outcomes were performed. Results: A weighted total of 38 783 hospitalizations were identified, with 6.1% of admissions occurring in pregnant women. On multivariable regression, pregnant women with obstructing ureteral stones and urinary tract infection were 38% less likely of undergoing decompression (adjusted OR: 0.62; p < 0.001) compared with nonpregnant women. Among those decompressed, pregnant women had greater odds of delayed decompression (adjusted OR: 2.28; p < 0.001) and longer length of stay (adjusted IRR: 1.11; p = 0.007). Delayed decompression among pregnant women was associated with increased rates of C‐section, early or threatened labor, fetal distress, and umbilical cord complications. Conclusions: Overall, pregnant women had reduced odds of decompression, as well as increased odds of delayed decompression, when compared with nonpregnant women of reproductive age. Delays in decompression among pregnant women were also associated with increased maternal and fetal complications. [ABSTRACT FROM AUTHOR]

Objectives: To determine if management of ureteric stones in the UK changed during the coronavirus disease 2019 (COVID‐19) pandemic and whether this affected patient outcomes. Patients and methods: We conducted a multicentre retrospective study of adults with computed tomography‐confirmed ureteric stone disease at 39 UK hospitals during a pre‐pandemic period (23/3/2019–22/6/2019) and a period during the pandemic (the 3‐month period after the first severe acute respiratory syndrome coronavirus‐2 case at individual sites). The primary outcome was success of primary treatment modality, defined as no further treatment required for the index ureteric stone. Our study protocol was published prior to data collection. Results: A total of 3735 patients were included (pre‐pandemic 1956 patients; pandemic 1779 patients). Stone size was similar between groups (P > 0.05). During the pandemic, patients had lower hospital admission rates (pre‐pandemic 54.0% vs pandemic 46.5%, P < 0.001), shorter mean length of stay (4.1 vs 3.3 days, P = 0.02), and higher rates of use of medical expulsive therapy (17.4% vs 25.4%, P < 0.001). In patients who received interventional management (pre‐pandemic 787 vs pandemic 685), rates of extracorporeal shockwave lithotripsy (22.7% vs 34.1%, P < 0.001) and nephrostomy were higher (7.1% vs 10.5%, P = 0.03); and rates of ureteroscopy (57.2% vs 47.5%, P < 0.001), stent insertion (68.4% vs 54.6%, P < 0.001), and general anaesthetic (92.2% vs 76.2%, P < 0.001) were lower. There was no difference in success of primary treatment modality between patient cohorts (pre‐pandemic 73.8% vs pandemic 76.1%, P = 0.11), nor when patients were stratified by treatment modality or stone size. Rates of operative complications, 30‐day mortality, and re‐admission and renal function at 6 months did not differ between the data collection periods. Conclusions: During the COVID‐19 pandemic, there were lower admission rates and fewer invasive procedures performed. Despite this, there were no differences in treatment success or outcomes. Our findings indicate that clinicians can safely adopt management strategies developed during the pandemic to treat more patients conservatively and in the community. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the simultaneous use of two devices versus a single device through a single working channel in flexible ureteroscopy using a ureteral access sheath for single ureteral stones. Methods: In a bench study, the time to (i) set laser fiber, (ii) exchange laser fiber and nitinol basket through working channel, and (iii) pull out the device from working channel were measured 10 times in each step. In a clinical study, 156 patients who underwent flexible ureteroscopy with a ureteral access sheath for a ureteral stone in middle and upper ureter between April 2019 and November 2021 were assessed. One device was used at a time for 79 patients (S‐Group) and two were simultaneously used for 77 (D‐Group). Surgical outcomes and complications were compared. Results: In the bench study, the mean time to change from laser fiber to basket and from basket to laser fiber through the working channel were 26.1 ± 3.7 s and 23.6 ± 2.0 s (p = 0.084), respectively, which were significantly longer than the laser setup time (p < 0.001). In the clinical study, although the stone‐free rate was not significantly different between the groups (S‐Group 89.8%, D‐Group 93.5%; p = 0.412), the median operation time was significantly shorter (p < 0.001) and the rate of postoperative stenting was significantly lower (p = 0.002) in the D‐Group. There were no significant between‐group differences in intra‐ and post‐operative complications. Conclusion: The simultaneous use of two devices through a single working channel is safe and could help save the time needed to exchange the laser fiber and nitinol basket. [ABSTRACT FROM AUTHOR]

Background: The usefulness of costovertebral angle (CVA) tenderness for the diagnosis of a suspected ureteral stone remains controversial. Methods: This single‐center, retrospective, observational study included patients aged 16–64 years with acute‐onset unilateral lower back pain or abdominal pain. The diagnostic accuracy of CVA tenderness was investigated. Results: In total, 132 patients met the criteria; 80 were diagnosed with ureteral stones. The sensitivity and specificity of CVA tenderness were 0.65 and 0.50, respectively; positive and negative likelihood ratios were 1.3 and 0.7, respectively. Conclusions: CVA tenderness cannot be used as a single diagnostic indicator to confirm or exclude ureteral stone diagnosis. The usefulness of costovertebral angle (CVA) tenderness in patients with suspected ureteral stones remains controversial. CVA tenderness does not contribute to the diagnosis of ureteral stones in this prospective observational study. [ABSTRACT FROM AUTHOR]

Seventy-two male patients, who were included in this study, underwent ureteroscopic stone surgery (study group). Forty-two healthy males were enrolled as control group. Changes in sexual function were evaluated using International Index of Erectile Function questionnaire in pre-operative, first and third postoperative terms. Overall satisfaction in relation to the age, operation time, presence of stents, body mass index, educational status, previous operations, International Index of Erectile Function score, International Prostate Symptom Score, Quality of Life, income status, Male Sexual Health Questionnaire, stone-free rates and Beck's depression scale were evaluated. Erectile and ejaculatory functions, quality of life and lower urinary tract symptoms were negatively affected due to ureteroscopic stone surgery, while educational status, psychogenic aspect and income status remained stable. In conclusion, ureteroscopic stone surgery with JJ catheterisation seems to have a progressively decreasing negative effect on male sexual function and whenever possible, stenting should be avoided. If JJ stenting is necessary, patients should be informed that they may experience sexual dysfunction at least for 3 months and if stenting proves necessary the indwelling should be kept as short as possible. [ABSTRACT FROM AUTHOR]

Objectives An obstructed, infected kidney combined with ureteral stones can be lethal, and requires urgent drainage and complete stone removal. However, the optimal method of stone removal, and its safety and efficacy have yet to be conclusively established. The aim of this study was to determine the safety and efficacy of carrying out ureteroscopy after kidney drainage for septic patients with obstructing stones. Methods From January 2004 to September 2011, 88 patients underwent stone removal by either ureteroscopy ( n = 48) or extracorporeal shock wave lithotripsy ( n = 40) after drainage of obstructive pyelonephritis. Patients' characteristics were analyzed, and treatment outcomes between the ureteroscopy and extracorporeal shock wave lithotripsy groups were compared. The outcomes of ureteroscopy carried out during the same period between patients with preoperative obstructive pyelonephritis and those without were also compared. Results Obstructed, infected kidneys were decompressed with retrograde ureteral stenting, except for two and three cases treated with nephrostomy in the ureteroscopy and extracorporeal shock wave lithotripsy groups, respectively. The severity of preoperative pyelonephritis was similar in both groups. Importantly, the success rate was 67.5% for extracorporeal shock wave lithotripsy and 98% for ureteroscopy ( P < 0.001). Likewise, the retreatment and auxiliary procedure rates were significantly greater in the extracorporeal shock wave lithotripsy group than in the ureteroscopy group (90% vs 0% and 32.5% vs 2%, respectively). Furthermore, patients treated by ureteroscopy with or without preoperative pyelonephritis had similar stone-free and ureteroscopy complication rates (97% vs 93%, and 10% vs 12%). Conclusions Ureteroscopy after drainage of an obstructed infected kidney can be a safe and effective option, as it seems to not be associated with an increased risk of complications. [ABSTRACT FROM AUTHOR]

The article offers information on a clinical investigation through randomized controlled trial (RCT) into the use of alfuzosin for medical expulsive therapy for patients with urethral stones less than 10 millimeter. It delineates the procedure of the investigation by means of the objectives of the trial, the RCT method employed, the results and conclusions drawn. The analysis was conducted by the Urology Division of the Pamela Yodel Nethersole Eastern Hospital in Hong Kong, China.

Objectives: We retrospectively evaluated our experience with a relatively uncommon procedure, the laparoscopic ureterolithotomy, for the treatment of ureteral stones. Methods: Between April 2002 and October 2006, a total of 74 patients (56 males, 18 females) with upper (54 cases), middle (18 cases) and lower (two cases) ureteral stones underwent laparoscopic ureterolithomy. The mean age was 39.4 years (range, 19–74). The stones were in the right side in 44 cases (59.5%) and in the left side in 30 (40.5%) cases. The mean stone size was 1.8 cm (range 1.5–2.8). The procedure was retroperitoneal in 66 cases (89.2%) and transperitoneal in eight (10.8%) cases. Laparoscopic guided flexible ureterorenoscopic extraction of kidney stone was carried out in one case as an adjuvant procedure. The ureter was stented and not sutured in 64 cases (86.5%). Results: The procedure was successfully completed in 94.6% of cases and an open conversion was carried out in four (5.4%) patients. The mean operative time was 58.7 min, and the mean blood loss was 90.6 mL. No major complications were encountered. Prolonged urinary leakage occurred in one patient. The mean hospital stay was 6.4 days. One patient developed ureteral stricture during follow up and was treated by endoscopic dilatation and stenting. Conclusion: In our experience laparoscopic ureterolithotomy represents a safe and effective treatment option for ureteral stones either as primary for large impacted stones or as a salvage procedure after failed shock wave lithotripsy or ureteroscopy. This procedure fulfills the advantages of minimal blood loss and analgesia requirements, good cosmetic appearance, short hospital stay and convalescence period. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the efficacy of low dose tamsulosin after extracorporeal shock wave lithotripsy (ESWL) in Japanese male patients with ureteral stone. Methods: One hundred and two Japanese male patients with ureteral stones who underwent ESWL were randomly divided into three groups. Group A (38 patients) was given tamsulosin (0.2 mg/day); group B (30 patients) was given c horeito, a herbal medicine (7.5 g/day); and group C (34 patients) received no medication. Stone clearance was assessed at 1, 7, 14, and 28 days after ESWL using plain abdominal radiography and abdominal ultrasonography. After 28 days, stone delivery was checked every 2 weeks. Results: The stone-free rate was 84.21%, 90%, and 88.24% for groups A, B, and C, respectively ( P = 0.3425). The mean expulsion time was 15.66 ± 6.14 days in group A, 27.74 ± 25.36 days in group B, and 35.47 ± 53.70 days in group C. The expulsion time of group A was significantly shorter than that of groups B ( P = 0.0116) and C ( P = 0.0424). Conclusions: The addition of tamsulosin to conservative treatment appeared to be effective in shortening the stone expulsion time. [ABSTRACT FROM AUTHOR]

Abstract Background: A 63-year-old woman presented with right flank pain and macroscopic hematuria. Results/Methods: A plain film showed a calcific shadow on the right iliac bone. On excretory urography, the right kidney was seen in the normal position, but the left kidney was not. Bilateral retrograde pyelogram revealed the S-shaped kidney and mild obstruction from a 12 × 5 mm calculus in the proximal ureter of the crossed kidney. The patient was successfully treated with in situ extracorporeal shock wave lithotripsy (ESWL) treatment and is stone free at 1 month follow up. Conclusion: We believe this is the first case of successful ESWL in a crossed kidney. [ABSTRACT FROM AUTHOR]

Recently, we reported that α1A adrenoceptor (AR) is the main participant in phenylephrine-induced human ureteral contraction. We therefore decided to carry out a prospective randomized study to evaluate the effects of silodosin, a selective α1A AR antagonist, as a medical expulsive therapy for ureteral stones. A total of 187 male patients, who were referred to our department for the management of symptomatic unilateral ureteral calculi of less than 10 mm, were randomly divided into two groups: group A (92 patients), who were instructed to drink 2 L of water daily, and group B (95 patients), who received the same instruction and were also given silodosin (8 mg/daily) for a maximum of 8 weeks. Expulsion rate, mean expulsion time and need for analgesics were examined. Overall, the mean expulsion time was 15.19 ± 7.14 days for group A and 10.27 ± 8.35 days for group B ( P = 0.0058). In cases involving distal ureteral stones, the mean expulsion time was 13.40 ± 5.90 and 9.29 ± 5.91 days, respectively ( P = 0.012). For stones of 1-5 mm in diameter, the mean expulsion time was 14.28 ± 6.35 and 9.56 ± 8.45 days, respectively ( P = 0.017). For stones of 6-9 mm in diameter, the stone expulsion rate was 30.4% and 52.2% ( P = 0.036), and the mean expulsion time was 21.00 ± 9.9 and 11.33 ± 8.31 days, respectively ( P = 0.038). Herein, we report the first on silodosin in the management of ureteral lithiasis. Our findings suggest that silodosin might have potential as a medical expulsive therapy for ureteral stones. [ABSTRACT FROM AUTHOR]

We report a rare case of ectopic ureter accompanied by a giant ureteral stone and pyonephrosis. A 19-year-old Japanese woman consulted our hospital due to low-grade fever and pain in the left flank. The patient had seeping urinary incontinence since childhood. Ultrasonography demonstrated left dysplastic lumbar kidney with hydronephrosis and plain kidney-ureter-bladder film showed a left giant ureteral stone. The left kidney showed no excretion of contrast medium on drip infusion pyelography. After further examination, a diagnosis of left simple ectopic ureter emptying into the vagina was made. Percutaneous nephrostomy penetrating the major psoas muscle was carried out for intractable pyonephrosis, followed by left nephroureterectomy and lithectomy. These procedures resulted in improvement in the patient's symptoms. [ABSTRACT FROM AUTHOR]

We report a case of uretero-appendiceal fistula. A 63-year-old woman was admitted to our hospital with high grade fever and loss of 5 kg of body weight over 6 months. Pyonephrosis was diagnosed. A retrograde ureterogram and barium enema showed a connection between cecum and ureter. Right nephroureterectomy and right hemicolectomy were carried out. The final diagnosis was uretero-appendiceal fistula. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the efficacy of ureterorenoscopy (URS) using a Holmium:Yttrium- Aluminum-Garnet (Ho:YAG) laser for the management of ureteral stone in Cikini Communion of Churches in Indonesia (CCI) Hospital. Methods: Data were collected retrospectively from patient's medical records in Cikini CCI Hospital from 1 January 2010-31 Desember 2012 who underwent URS with a Ho:YAG laser lithotriptor to treat ureteral stone diseases. The inclusion criteria was all patients with ureteral stone treated by URS using a Ho:YAG laser. Results: As many as 205 ureteral stone diseases from 182 patients were treated by URS with a Ho:YAG laser lithotriptor in Cikini CCI Hospital, they comprised of 143 men and 39 women with the mean age of 45.69 years (19 to 76). There were 115 right and 90 left ureteral stones, with 128 proximal versus 77 distal ureteral stones. The most common comorbidity was hydronephrosis up to 169 (88.5%) and 12 (6.28%) other comobidities from all other causes. Post operative complications were found in 11 patients (5.8%). Mean operation time was 48.2 minutes and mean post operative hospital stay was 2.9 days. The stone free rates for proximal and distal ureteral stones were 85.9% and 89.6% respectively (P = 0.340), with the overall stone free rates was 88.3%. Conclusion: URS with a Ho: YAG laser is a safe and effective procedure for the management of ureteral stone with high stone free rates irrespective of stone location. [ABSTRACT FROM AUTHOR]

Aim: To determine the value of Efficacy Quotient (EQ) of ESWL (Extracorporeal Shockwave Lithotripsy) using Piezolith Richard Wolf 3000 machine and the stone free rate for the treatment of ureteral stone patients in Cipto Mangunkusumo hospital from 2008-2011. Methods: Design of the study was a survey method that was both descriptive statistical multivariate analytical study. Demographic characteristics, clinical presentation, and stone characteristics of patients with ureteral stone in Cipto Mangunkusumo hospital were retrospectively collected. Th ese were then correlated with stone free rate. Survey was conducted to these patients to evaluated presence of urinary stone current symptoms. The datas collected from medical record includes gender, stone size, stone location, number of stone, radioopacity, obstruction, renal function, and the additional procedures during ESWL. Analysis was made using SPSS soft ware version 17 of Windows. Results: From 222 patients, only 119 patients were able to followed, 90 male patients (75.6%) and 29 female patients (24.4%). Mean age was 46.36 ± 12.407 years. Most stones were less than 10 mm (81; 68.1%). The number of proximal and distal ureteral stone cases were almost identical, namely 59 (49.6%) and 56 (47.1%). 109 patients (91.6%) were presented with single stone, 90 patients (75.6%) had radioopaq stone, only 1 patient (1%) required additional procedures such as insertion of DJ stent. Patients's renal function were normal in average 109 (91.6%) patients, 70 patients (58.8%) presented with hydronephrosis/hydroureter. Evaluation at three month post ESWL revealed patients with residual stones in 64 patients (53.8%). Only 6 patients (5%) underwent re-ESWL. 113 (95%) of 119 patients were stone free after the first ESWL. EQ value was 0.89. Stone size was the only factor that correlated significantly with stone free rate (P < 0.05). Conclusion: We concluded that ESWL procedure using Richard Wolf Piezolith 3000 machine at Cipto Mangunkusumo Hospital for the management of ureteral stone patients had better efficacy quotient and better stone free rate than previous reports using similar machines. [ABSTRACT FROM AUTHOR]