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Metastatic ureteral masses are not rare, but isolated ureteral metastasis from the origin of gastric cancer is rare. Ureteral metastasis is usually unilateral and does not lead to postrenal azotemia unless in single kidney patients. Herein, we describe an 80-year-old man with a history of nonmetastatic gastric cancer who presented with postrenal azotemia due to the coincidence of right distal ureteral metastasis and left distal ureteral stone.

Spontaneous rupture of the ureter is a rare entity most commonly a result of ureteral stone disease. Despite the overall low prevalence, the diagnosis should be considered so appropriate imaging and management can be performed without delay. Although treatment has shifted towards more minimally invasive intervention and conservative management, open surgical intervention should be considered in certain situations to mitigate the risk of long-term complications. Here we present a unique case of spontaneous ureteral rupture complicated by recurrent infections and fistulous sinus tract formation.

Objective: The aim of this study was to describe and characterize the analgesic and opioid use for patients discharged from the emergency department (ED) with renal colic due to ureteral stone. Methods: This is a secondary analysis of a multicenter prospective trial of ED patients diagnosed by CT scan as having a symptomatic ureteral stone

Background:. We aimed to determine if the ratio of the upper to the lower diameter of the ureter could have any predictive value for ureteral stone impaction. Materials and methods:. Patients who had a solitary unilateral ureteric stone, determined by noncontrast computerized tomography, were assessed if they had undergone ureteroscopic lithotripsy. A total of 111 patients, 84 males (76%), and 27 females (24%), were recruited to the study. Demographic data of the patients and preoperative radiological parameters based on noncontrast computerized tomography were recorded. The impaction status was also assessed during the operation. Results:. Of the 111 patients, ureteral stones in 63 (57%) patients were determined to be impacted, and ureteral stones in 48 (43%) were nonimpacted. Impacted stones were more common in older patients, female patients, and patients with an American Society of Anesthesiologists score of 2. Conclusions:. Significant relationships were found between the impaction status and transverse stone length, longest stone length, upper diameter of the ureter, ratio (upper diameter of the ureter/lower diameter of the ureter), and anteroposterior diameter of the pelvis. These parameters were higher in patients with impacted stones.

BACKGROUND: To compare the safety and validity of a suctioning semirigid ureteroscopic lithotomy (Sotn-URSL) and minimally percutaneous nephrolithotomy (mPCNL) in treating upper ureteral stone larger than 15 mm. METHODS: Between February 2018 and December 2019, 97 patients who had upper ureteral stone >15 mm were consecutively included in this study. Forty-six patients underwent Sotn-URSL and 51 underwent mPCNL by the same surgeon. The following parameters were retrospectively assessed: patient and stone characteristics, surgical details, perioperative outcomes, and stone-free rates (SFRs). RESULTS: No significant difference was observed in two groups for patient and stone characteristics, except that mPCNL group had a higher incidence of severe hydronephrosis (19.6% vs. 41.2%, P=0.021). Sotn-URSL group was similar to mPCNL group in terms of the mean duration of surgery (50.5±5.9 vs. 52.9±8.0 min, P=0.106) and the SFR after 1 month (91.3% vs. 98%, P=0.187). The hospital stay after surgery of Sotn-URSL group was significant shorter than mPCNL group (1.4±0.6 vs. 2.3±0.7 days, P15 mm. Nevertheless, further well-designed studies with long-term follow-up are needed to confirmed the results.

Objective: To investigate the effect of four different techniques used in the treatment of ureteral stones on patients' daily physical functioning (PF) and quality of life (QoL). Materials and Meth...

Background: The COVID-19 is a challenge for both patients and physicians in emergency department (ED). This study was aimed to report the impacts of the COVID-19 outbreak on visits and treatments for patients with ureteral stones in a general hospital ED. Methods: The patients with ureteral stones were collected from 24 January to 24 March 2020 during the COVID-19 outbreak in Beijing. Two periods were divided for study: 24 January to 24 February (Period 1) and 25 February to 24 March (Period 2). Data on patients’ characteristics, attendance, visual analog scale (VAS) scores, stone features, and final treatment choices were retrieved from the computer and compared with the data in the same periods in 2019. Results: The study included 376 patients with ureteral stones during the COVID-19 outbreak periods in 2020 and 343 patients during the same periods in 2019. Compared with the same periods in 2019, the number of patients with ureteral stones was less in Period 1 (137 vs 163) but had a rebound phenomenon in Period 2 (239 vs 180). The visit frequency was significantly reduced (2.6 ± 0.4 vs 3.6 ± 0.8, p Conclusion: These results showed that the COVID-19 outbreak can directly affect the visits and final treatment choices for patients with ureteral stones.

Background: The optimal treatment of ureteral stones, particularly the lower ureteral stone, still controversial[5,13,15,18]. Objective: To assess the success rate of ESWL and tamsulosin in lower ureteral stone. Also to identify the parameters that affects the success rate of ESWL in the lower ureteral stone. Patients and Methods: Prospective study has been done on thirty-six patients sequentially selected from referred cases to the ESWL department in Sulaimania Teaching Hospital in the period from June, 2010 to January, 2011). All had radioopaque lower ureteric stone (from the lower border of sacroiliac joint to uretero-vesical junction). Stones ranging from (5.8 to14mm), twenty in the left side and sixteen in the right side , age ranging from (10 to 78 years), and only four of them had double J-stent (within 1 week before ESWL). Weekly follow up of all patients were done by U/S and twice-weekly by KUB for 6 weeks. Results: Twenty four cases (66.7%) were free of stone, five cases (13.9%) had residual stone and seven cases (19.4%) failed to respond, the most important two parameters that affect the result are the size of stone and number of sessions. Conclusion: ESWL is safe and useful, and it is considered to be the first favorable line of intervention for lower ureteric stones after failure of watchful waiting and medical expulsion therapy especially those without complications like obstruction. Keywords: Lower ureteric stone, extracorporeal shock wave lithotripsy

Giant ureteral calculi stones defined as larger than 5 cm in length or circumference. Although many giant ureteral stones have been reported, the laparoscopic removal of these stones is rare. A 45-year-old male patient presented to our clinic with right flank pain and discomfort from 6 months ago. Abdominopelvic computed tomographic scan showed a giant left middle ureteral stone. On the first stage laparoscopic ureter lithotomy was performed with 3 ports and the stone was extracted from 12 mm port successfully. We used transperitoneal laparoscopic approach in the full lateral decubitus position. three trocars were placed: one camera 11-mm port was placed at the level of the umbilicus on the lateral border of the rectus muscle, a 5-mm port was placed in the midline below the umbilicus, and a 12-mm port was at the superior border of the rectus muscle. The extracted stone size was 6.5*1.7 cm with 33 gm in weight. Due to the advantages of laparoscopic ureter lithotomy in giant ureteral stones and its feasibility to perform in a single session, we could suggest this minimally invasive treatment as a first choice in this group of patients., Highlights • Treatment of giant ureteral stone is a subject of controversy in urology. • Here we report the third largest ureteral stone in the world which was extracted by laparoscopic technique. • Laparoscopic ureter lithotomy could be suggested for giant ureteral stones as a preferred treatment.

Antegrade flexible URSL is a minimal invasive option for treating distal ureteral stones in patient after urinary diversion.

Background: Ureteral stents are a crucial part of urologic surgeries. Complications of Double J stenting (DJS) include migration, fragmentation, and encrustation. In addition, forgotten stents with encrustations and stone formations are difficult to remove. Case Presentation: We report the case of a stent “forgotten” for 10 years, which migrated downward into the proximal ureter, concomitant with multiple ureteral stones and bladder calculus. Whole encrustation of the stent was observed. The “forgotten” stent was positioned 10 years ago during right ureteral stone treatment in the Philippines. In the end, the patient underwent laser cystolithotripsy, stone elimination, ureteroscopic laser lithotripsy and stent removal. The final X-ray post-intervention revealed the absence of any stone fragment or residual DJS fragment. Conclusion: We report the longest period of forgotten DJS with maximum stone burden in the urinary system. To avoid this situation, patients should be educated regarding complications if the stent is not removed within a short period. Moreover, a computerized registry of stent placement can be used to alert the urologist when the stent ought to be removed.

To determine the predictive value of the delta neutrophil index (DNI) for acute pyelonephritis (APN), which increases in conditions of infection and inflammation.Observational, comparative cross-sectional study.Department of Urology, Kahramanmaraş Sütçü İmam University, Turkey, from December 2014 to November 2019.The data of 205 patients, diagnosed with ureteral stone and urinary tract infection (UTI), were evaluated. For comparison, patients were categorised into two groups: those with lower UTI (LUTI) and those with APN. Together with demographic data of patients and ureteral stone, DNI, C-reactive protein (CRP), white blood cell (WBC) and other biochemical parameters were analysed.There were 165 patients (80.5%) in the LUTI group and 40 patients (19.5%) in the APN group. In univariate analysis, age (p=0.023), creatinine (p=0.001), PT/INR (p=0.007), WBC (p0.001), CRP (p=0.002) and DNI (p0.001) were identified as predictors of APN. In multivariate analysis, CRP (p=0.019) and DNI (p=0.009) were significantly associated with the predictors of APN. Cut-off values were 11.75 mm3 for WBC, 22.2 mg/dL for CRP, and 1.3% for DNI. DNI value was positively correlated with WBC and CRP (r=0.369 vs. 0.740 and p0.001, each).As an infection marker that can be monitored with a complete blood count and does not require additional costs, DNI can be used as an early predictor of APN. Patients with a DNI value of1.3% should be considered for early intervention. Key Words: Ureteral stone, Acute pyelonephritis, Delta neutrophil index, C-reactive protein, White blood cell.

Author(s): Shavor, Cindy; Pagenhardt, Justine; Sun, YuanYuan; Kraft, Clara; End, Bradley; Minardi, Joseph | Abstract: Introduction: Abdominal pain is a common complaint in the emergency department. Point-of-care ultrasound (POCUS) is a rapid modality to evaluate for the etiology.Case Report: A teenage male presented with symptoms concerning for appendicitis. POCUS revealed a non-peristalsing, non-compressible, tubular structure containing an echogenic stone. This was determined to be a ureteral stone within a dilated ureter, not appendicitis.Conclusion: We propose a syndromic sonographic approach to right lower quadrant pain (RLQ) that includes the gallbladder, right kidney, bladder, and right adnexa, in addition to RLQ landmarks. This case emphasizes the value of such an approach to avoid diagnostic error.

Objective To evaluate the efficacy and safety of the semi-rigid URS with pneumatic lithotripsy for the treatment of large (>10 mm) proximal ureteral calculi. Study design Cohort study. Place and duration of study Section of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan, from January 2010 to December 2018. Methodology All patients with single, radio-opaque unilateral proximal ureteral stones >10 mm were included in the study. Patients with urosepsis, pregnancy, solitary kidney, and indwelling JJ stent or prior percutaneous nephrostomy drainage were excluded. Patients without any visualisation of stone on abdominal X-Ray done at 4 weeks of the procedure were labelled as stone-free. Results One hundred and three cases with stones >10 mm and fulfilling the selection criteria were included. The mean age was 40.83 + 14.92 years. The mean stones size was 13.33 + 4.64 mm. The mean procedure time was 41.50 + 15.60 minutes. Indwelling JJ stents were placed in 49 (47.6 %) cases. The stone-free rate was 83.5% at four weeks with calculated efficiency quotient (EQ) of 0.72, using a standard equation. The overall complication rate was 27% with the majority being minor (Clavian-Dindo grade 1). Only one patient had urosepsis (MCG IV). Ancillary procedures were performed in 17 (16.5%) cases, most commonly the extracorporeal shock wave lithotripsy (ESWL) in 14 (13.5%) cases, followed by the secondary URS in 3 (2.9%) cases. Conclusion Semi-rigid URS is an effective and safe procedure for the large proximal ureteral stones, with limited access to flexible instruments. Key Words: Ureteroscopy, Semi-rigid, Stone, Proximal, Clearance, Safety.

To evaluate the efficacy of sexual intercourse in the expulsion of distal ureteric stones in women. A total of seventy woman patients with distal ureteral or intramural stone were randomly divided into two groups. Group 1 included 35 patients who were advised to do sexual intercourse 3–4 times/week with the administration of symptomatic treatment, and group 2 (control group) included 35 patients receiving symptomatic treatment only and were instructed not to do sexual intercourse or masturbation during the study. After 4 weeks follow up; the expulsion rate, need for analgesic and ureterorenoscopic lithotripsy were compared for each group. The mean ages of the patients in groups 1 and 2 were 36.4 ± 10.8, 37.1 ± 12.4, respectively. The mean stone size was 7.01 ± 1.6 in group 1, 6.67 ± 1.4 mm in group 2 (p: 0.3). Stone expulsion rate, in the first 2 weeks for group 1 was 80% (28/35), while 51.4% (18/35) in group 2 (p

We assessed the accuracy of patient reported outcomes for predicting spontaneous ureteral stone passage.Patients with new unilateral ureteral calculi were prospectively assessed regarding current symptoms and whether they believed their stone had passed. The primary outcome was successful spontaneous stone passage as confirmed by ultrasound, and kidney, ureter and bladder x-ray. Spontaneous stone passage was compared to patient reported outcome responses to assess accuracy.Of the 212 patients 105 (49.5%) had successful spontaneous stone passage at a mean followup of 17.6 days. Compared to the unsuccessful spontaneous stone passage group, those with successful spontaneous stone passage had significantly smaller (mean 5.4 vs 7.6 mm), more distal (71.4% vs 34.6%) stones with slightly longer average time to followup at first visit (19.2 vs 16.0 days). Additionally, there was more patient reported cessation of pain (77.1% vs 44.9%) and perceived stone passage (55.2% vs 13.1%) in this group. Cessation of pain was 79.7% (95% CI 67.1-89.0) sensitive and 55.8% (95% CI 44.0-67.1) specific for successful spontaneous stone passage. Likewise, patient reported stone passage was 59.3% (95% CI 45.7-71.9) sensitive and 87.0% (95% CI 77.4-93.5%) specific. In the multivariable logistic regression analysis cessation of pain (OR 4.02, 95% CI 1.91-8.47, p0.01) and reported stone passage (OR 3.79, 95% CI 1.73-8.28, p0.01) were independent predictors of successful spontaneous stone passage.Cessation of pain and patient reported stone passage are independent predictors of successful spontaneous stone passage. However, both assessments may incorrectly gauge spontaneous stone passage, which raises concern for their validity as a sole clinical end point.

Currently, when performing ureterolithotripsy in patients with proximal ureteral stones, urologist should be ready for intraoperative complications and be able to use various methods to diagnose them. Ureteral avulsion is an extremely rare, but the most serious complication of endoscopic procedures. Clinical observation of autologous kidney transplantation performed after ureteral avulsion with good functional and clinical results is presented.

Introduction and Objectives: To determine the optimal guidewire for bypassing an impacted ureteral stone. Materials and Methods: Three different benchtop models of varying impaction (300, 362, and ...

Objective:In this study, we aimed to determine the contribution of hounsfield unit (HU) measurement with non-contrast-enhanced computed tomography to the treatment of a single ureteral stone, and compare the value of HU and intraoperative “GATA scale” score in deciding for DJ stent placement in patients with a single ureteral stone.Materials and Methods:Ninety patients diagnosed with a single ureteral stone in our clinic between January 2018 and September 2018 were evaluated prospectively. We planned a new scale called “GATA scale” with three benchmarks. The validity and reliability of HU were compared with those of GATA scale score. Statistical significance was defined as p

Background and Purpose: Classically, abdominal X-ray (KUB), ultrasound, or a combination of both have been routinely used for ureteral stone surveillance after initial diagnosis. More recently, ult...

The association between mean stone density (MSD) and ureteroscopic lithotripsy outcome remains controversial. MSD automatically measured by 3D images of stones (3D-MSD) was recently reported to be more useful than manual measuring methods for predicting outcomes of shock-wave lithotripsy. This study aims to investigate whether 3D-MSD can predict ureteroscopic lithotripsy outcome. We retrospectively identified 218 patients who underwent ureteroscopic lithotripsy for kidney stones (n = 135) and ureteral stones (n = 83) between February 2011 and April 2017 with pretreatment non-contrast computed tomography (NCCT) at our hospital. Stone volume and 3D-MSD were automatically measured using high functional viewer. Logistic regression analysis was performed to identify factors contributing to treatment failure. Treatment failure was determined as residual fragments ≥ 4 mm using NCCT within 3 months after operation. Treatment failure rate was 20.1% (44/218 cases). Patients in treatment failure group had higher percentage of kidney stones (

This study aimed at evaluating whether removal of the ureteral stent the day before scheduled secondary intervention facilitates spontaneous ureteral stone passage and thus can spare the pre-stented patient this surgery. Retrospective analysis of a single-centre consecutive series of 216 patients after previous stenting due to a symptomatic ureteral stone from 01/2013 to 01/2018. Indwelling stents were removed under local anaesthesia. Patients were told to filter their urine overnight. Multivariate analysis was performed to assess predictive factors for spontaneous stone passage. 34% (74/216) of patients had spontaneous stone passage while the stent was indwelling. Of the remaining 142 patients, 41% (58/142) had spontaneous stone passage within 24 h after stent removal. Only 84/216 (39%) patients needed secondary intervention. Multivariate logistic regression analysis of all 216 patients showed a significant association between spontaneous stone passage and smaller stone size (p

Introduction Ureteroscopy with pneumatic lithotripsy is a relatively safe procedure for the management of the ureteral stone disease. However; subcapsular hematoma and even huge perinephric hematoma are potentially serious events that may complicate this procedure and must be kept in mind. Case presentation We present a case of huge perinephric hematoma post ureteroscopy and pneumatic lithotripsy for an impacted ureteral stone. Conclusion The occurrence of such a rare complication in a relatively safe procedure must be taken into consideration especially while dealing with patients with long-standing obstruction and thin renal cortex. Furthermore, the risk of bleeding should be included in risk-benefit counselling before ureteroscopic lithotripsy.

Introduction Ureteroscopic lithotripsy has become the first choice for the treatment of middle and lower ureteral stones, but it still has a certain rate of surgical failure. Here we aimed to determine the factors that may affect the success rate of holmium laser ureterolithotripsy (HLU) and provide the basis and guidance for its future use. Aim To evaluate the risk factors for HLU failure. Material and methods The clinical data of 385 patients undergoing holmium laser ureterolithotripsy from 2009 to 2012 were retrospectively reviewed to analyze the impact of gender, age, stone side, stone size, stone location, stone number, degree of hydronephrosis, stone impaction, previous extracorporeal shock lithotripsy (ESWL), and associated urinary tract infection (UTI) on the success or failure of surgery. Results Surgical success was achieved in 338 (87.8%) patients versus surgical failure in 47 (12.2%) patients. Univariate analysis revealed that the degree of hydronephrosis (p = 0.024), stone impaction (p = 0.003), stone location (p = 0.012), and previous ESWL (p = 0.037) were risk factors for surgical failure. Multivariate logistic regression revealed that stone impaction (odds ratio (OR) = 2.66; p = 0.018) and stone location (OR = 2.11; p = 0.013) were significantly associated with surgical failure. Since some cases of ureterostenosis developed postoperatively, we continued follow-up. The patients had the stent for a year and underwent regular follow-up checks until 5 years. No cases of ureterostenosis recurred. Conclusions Ureteroscopic lithotripsy is a safe procedure with few complications. Stone impaction and proximal location are the risk factors for its failure.

Background This study aimed to evaluate the association of asymptomatic pyuria before ureterorenoscopic lithotripsy (URSL) with postoperative febrile urinary tract infection (UTI). Methods This observational case–control study identified the patients undergoing URSL for ureteral stones between May 2011 and October 2015. The included patients were classified into two groups: the asymptomatic pyuria group (6–50 white blood cells [WBCs]/high-power field [HPF]) and the non-pyuria group (≤ 5 WBCs/HPF). All data were collected by reviewing medical records. Postoperative outcomes were collected in terms of febrile UTI, emergency visits, and stone-free rate. Results A total of 232 patients were included, 101 in the pyuria group, 131 in the non-pyuria group. Two (0.9%) patients developed febrile UTI after URSL and 12 (5.2%) patients visited emergency department for URSL-related symptoms. The overall stone-free rate was 90.9%. There was no significant difference between the pyuria and non-pyuria groups regarding febrile UTI, emergency visits, and stone-free rate. Multivariate analysis revealed that pyuria was neither significantly associated with postoperative febrile UTI (OR = 1.03, 95% CI = 0.06–18.10, P = 0.98), nor with emergency visits (OR = 0.48, 95% CI = 0.13–1.85, P = 0.29). Conclusions Compared to the patients with sterile urine prior to URSL, those with asymptomatic pyuria were not prone to develop febrile UTI after URSL.

Purpose: We aim to review our experience of transperitoneal laparoscopic ureterolithotomy (TPLU) for proximal ureteric stone more than 15 mm. Patients and methods: Between June 2017 to December 2020, sixty patients with a history of unsuccessful Extracorporeal shock wave lithotripsy (ESWL) and/or failed ureteroscopy for impacted ureteral calculi more than 15 mm who accepted TPLU were enrolled in our study. The patients' demographic information and post-treatment results were gathered and analyzed, retrospectively. Results: The patients' mean age was 46.25 ± 12.56 years. The mean size of the stone was 20.11 ± 4.76 mm. 37 (61.7%) patients had severe hydronephrosis (HDN) and 46 (76.7%) stones were radio-opaque. Almost all of the patients underwent TPLU by a single urologist. The mean operation time was 72.86 ± 6.07 minutes without intraoperative complication (only 3 stones had upward migration to the pyelocaliceal system). The main operative blood loss was 88.86 ml. The average length of stay in the hospital was 45.8 ± 8.11 hours. The stone free rate (SFR) at discharge was 57 (95%). The overall complication rate was 27 (45%). Regarding early complications, fever was found in 8 (13.3%) patients, and 3 patients (5%) had paralytic ileus. The rate of urine leak was 8.3%, and 8 (13.3%) patients required blood transfusions. In multivariate analysis, the multiple stones, bigger stone in size, incomplete SFR, longer duration of hospital admission, and severe HDN were associated with a high early complication rate (p = 0.05, 0.04, < 001, 0.03, and 0.01, respectively). Conclusions: TPLU is a harmless option for managing proximal ureteric stone as a primary procedure or salvage procedure with good outcomes and acceptable complication rates.

INTRODUCTION AND OBJECTIVE:Minimizing retropulsion may improve surgical efficiency during ureteroscopic lithotripsy. This study seeks to determine if reverse Trendelenburg (RT) positioning during u...

INTRODUCTION AND OBJECTIVE:Ureteral access sheaths (UAS) are used during ureteroscopy to facilitate passage of the ureteroscope and the extraction of renal and ureteral stone fragments. Larger UAS ...

Background Identifying the precise location of the lower ureter is crucial in not only ureteral surgeries but also the other surgeries that may cause ureteral injury. Although a variety of approaches have been applied to detect the location of the lower ureter, the majority of them had an association with several complications or be difficult to perform perfectly or be time-consuming. Case presentation Seven patients with distal ureteric stones of the size ranged from 2 to 3 cm. All patients entered the study after signing the informed consent, and the case report is based on CARE guidelines. After specifying the inner ring of the inguinal canal, the posterior peritoneum was opened and dissected from an area of 2 cm medial and 2 cm inferior to the inner ring. Thereafter, the stone was extracted from the precise location of them, which was identified by ureteral pinching. Conclusion We assumed that we were easily able to identify the site of the lower ureter through 2 cm medial and 2 cm inferior to the inner ring. The result of our study on seven patients demonstrated that this maneuver can minimize the time of surgery and no complications have been seen while this approach was applied.

Background: We aimed to investigate the factors predicting the need for ureteral J stent placement in the treatment of distal ureteral stones by ureteroscopy (URS). Methods: Between January 2007 and June 2018, 550 consecutive patients who underwent URS with the diagnosis of distal ureteral stone disease were evaluated in a single center. The patients were divided into two groups as; group 1 who received a ureteral J stent, and group 2 without ureteral J stent. The two groups were compared in terms of possible preoperative, perioperative and postoperative risk factors. Results: History of systemic disease, stone disease and extracorporeal shock wave lithotripsy (SWL) were significantly higher in group 1 (P < 0.001, P= 0.009, P = 0.016). The operation time was longer in group 1 (P < 0.001). The rate of impacted stones was higher in group 1 (61.7% vs 15.6%; P < 0.001). In multivariate analysis, co-morbidities, previous SWL history, presence of impacted ureteral stone and prolongation of the operation time were found to be statistically significant in predicting ureteral J stent placement. Conclusions: In the treatment of distal ureteral stones by URS, not only perioperative complications, prolongation of the operation time, and the presence of residual stones but also preoperative factors, such as systemic disease, and impacted ureteral stones should be considered as predictive factors in assessing the need for a ureteral J stent and to avoid unnecessary stent procedures.

Objective: This study aimed to evaluate the efficacy of ureteroscopy lithotripsy (URS) using laser lithotripsy compared to pneumatic lithotripsy for ureteral stone management. Material & Methods: A systematic search was conducted in PubMed and ScienceDirect. The search and screening process in this study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline to include relevant RCTs. The included studies were assessed for their risks of bias using the Cochrane risk of bias tool 2 (RoB 2). The comparison of outcomes, which includes stone-free rate, DJ-Stent use, and mean fragmentation time between laser and pneumatic lithotripsy was analyzed using Review Manager 5.4. Results: A total of 11 RCTs evaluating a total of 235 patients with ureteral stone were analyzed in this review. Compared to pneumatic lithotripsy, laser lithotripsy has a significantly higher stone-free rate (OR 2.39, 95% CI 1.78-3.21, p < 0.001), longer mean fragmentation time (MD 4.11, 95% CI 3.17-5.04, p < 0.001), and lower DJ stent use rate (OR 0.53, 95% CI 0.36-0.76) based on the forest plot analysis. Conclusion: Patients undergoing laser lithotripsy have a higher stone-free rate, a lower DJ stent use rate, and albeit a longer mean fragmentation time compared to pneumatic lithotripsy.

A 12‐year‐old boy received steroid for his minimal change nephrotic syndrome for 10 years, and bilateral renal and ureteral stones and hydronephrosis were observed. Single‐use flexible ureteroscopy is usable for pediatric lithotripsy with Ho: YAG laser.

Introduction: A routine treatment of ureteral stones is using ureteroscopic lithotripsy, a common problem of which is retropulsion of the stone to the renal pelvis and calyces that reduces the rate of lithotripsy’s success. In this study, we aim to investigate the safety and success of using wire basket to hold the stones along with pneumatic lithotripstic probe in endoscopic lithotripsy of ureteral stones. Methods: Patients with ureteral stone were randomly divided to groups A and B. Group A (control) undergone lithotripsy without basket and group B (case) with wire basket along with pneumatic lithotripsy. In addition to demographic and clinical data, rate of success, retropulsion and residual stone with a size of greater than 3 mm were collected, before, during and after lithotripsy. Additionally, the total duration of lithotripsy and ureteral traumatic side effects was also recorded in both groups. All the patients were followed up until their discharge. Data was analyzed using SPPSS ve. 20. Results: There was no significant difference between groups by the point of demographic data. When compared together, there was no significant difference between the location, side and size of the stone and duration of the lithotripsy in both groups. The rate of lithotripsy success was significantly higher in the case group. The incidence of retropulsion and need for a secondary intervention was significantly higher in the control group. We didn’t have any ureteral trauma in neither control nor case group. Conclusion: Based on the results of this study, using wire basked as an anti retropulsion device increases the stone free rate in addition to it’s easy applicability, So it can be useful in treatment of ureteral stone.

Introduction: Transurethral lithotripsy (TUL) is an appropriate treatment for ureteral stones and is usually used for stones in the middle and lower part of the ureter. Different devices such as the Holmium laser, the stone basket, and the stone cone exist to prevent any fragments from retropulsion during TUL. The present study aims to compare the advantages and disadvantages of the Holmium laser, the stone basket, and the stone cone. Methods: A retrospective study was conducted from September 2016 to January 2018 comparing various TUL methods in 88 subjects with proximal ureteral calculi. The study participants were divided into 4 matched groups. The first one included 20 patients undergoing TUL with no device (group 1), the second group included 22 patients undergoing TUL while using the stone retrieval basket, the third group included 18 patients undergoing TUL while utilizing the stone cone and the fourth group included 28 patients undergoing TUL while using the Hol-YAG laser. Results: A residual stone ≥3 mm was recorded in 15.9% of the patients. The stone free rate was seen in 100%, 90.9, 83.3%, and 55% of the Holmium laser group, the retrieval basket group, the stone cone group and the no device group respectively (P=0.001). The lowest rate of surgery complications including ureteral perforation, post-operative fever, and mucosal damage between the 4 groups (P=0.003) and the highest time of surgery (P=0.001) belonged to the laser group. If we want to ignore the laser group, the success rate for lithotripsy was better in both groups with a stone retrieval device compared to the no device group, but no advantage existed between the stone basket and the stone cone. Conclusion: We can safely conclude that lasers significantly help to prevent stone migration during TUL. If we want to ignore the laser group, the success rate for lithotripsy was significantly better in both groups with a stone retrieval device compared to the no device group, but no advantage existed between the stone basket and the stone cone.

Objective: To examine differences in outcomes of semi-rigid ureteroscopy (URS) with or without a modified-ureteral-access-sheath (mUAS) to treat large upper ureteral stones. Methods: Patients with single, radio-opaque large upper ureteral stone (≥10 mm) treated using semi-rigid URS between August 2013 and October 2016 were retrospectively evaluated. The stone-free status was determined from Kidney-ureter-bladder (KUB) X-ray films taken on postoperative Day 1 and after 1 month. Results: Of 103 patients meeting inclusion criteria, 43 (41.75%) and 60 (58.25%) were treated with semi-rigid URS with and without mUAS, respectively. The immediate stone-free rate (SFR) for the mUAS group was significantly higher than the non-mUAS group (40 [93.0%] vs. 46 [76.7%]; p = 0.033). The SFR at 1 month was also high for patients treated using mUAS, but not statistically different from patients not treated with mUAS (41 [95.3%] mUAS vs. 51 [85.0%] non-mUAS; p = 0.115). Auxiliary procedure rates were significantly lower for mUAS patients compared to non-mUAS patients (2 [4.7%] vs. 14 [23.3%]; p = 0.01). There were no significant differences in surgical duration and hospital stays, and the overall complication rates were statistically similar for mUAS patients compared to non-mUAS patients (1 [2.3%] vs. 3 [5.0%]; p = 0.638). Conclusion: Application of mUAS to treat large upper ureteric stones was associated with higher immediate SFR and final SFR, and lower auxiliary procedure rates relative to patients treated without use of mUAS. Moreover, the use of mUAS did not lengthen operation duration or hospital stays. Keywords: Ureteroscopy, Semi-rigid, Large ureteral stones, Ureteral access sheath, Modified ureteral access sheath

Backgrounds/aims Operation room (OR) time is of great value affecting surgical outcome, complications and the daily surgical program with financial implications. Methods We retrospectively evaluated 570 consecutive patients submitted to ureteroscopy or ureterorenoscopy for the treatment of ureteral or renal stones. Demographic parameters, patient's stones characteristics, type of ureteroscope, surgeon experience and surgical theater characteristics were analyzed. OR time was calculated from the initiation of anesthesia to patient extubation. Multivariate analysis was conducted using a linear regression test with multiple parameters to identify predictors of OR time. Results Eight factors were identified as significant. These include total stones volume, ureteroscope used, stone number, nurses experience, radio-opacity of the stone on kidney-ureter-bladder X-ray, main surgeon experience, operating room type, and having a nephrostomy tube prior to surgery. Conclusions The surgical team experience and familiarity with endourological procedure, and the surgical room characteristics has a crucial impact on OR time and effectiveness.

Background Naftopidil combined with an antispasmodic agent and a supplement that facilitates stone expulsion has reportedly produced an increased rate of ureteral stone expulsion. A randomized controlled study was conducted to determine the efficacy of naftopidil as a medical expulsive therapy for male patients with ureteral stones. Methods Male patients (n = 500) with stones from the upper to the lower ureter were randomized to one of four groups and followed for 1 month to assess spontaneous passage of stones. The control group received only analgesics. The other three groups received daily doses of 240 mg flopropione, an antispasmodic agent and 1,350 mg extract of Quercus salicina Blume/Quercus stenophylla Makino (QS), a supplement that facilitates stone expulsion; 50 mg naftopidil; or 50 mg naftopidil in combination with 240 mg flopropione and 1,350 mg QS. Stone expulsion and characteristics were evaluated by urinalysis; kidney, ureter and bladder X-ray; ultrasound; and computed tomography. Results The probability of expulsion of ureteral stones < 6 mm increased 1.570-fold (95% confidence interval (CI): 1.039 - 2.374, P < 0.05) with naftopidil compared to control; the probability of expulsion of a lower ureteral stone < 6 mm increased 1.778-fold (95% CI: 1.066 - 2.965, P < 0.05) with naftopidil compared to control. None of the stones > 6 mm spontaneously passed. Conclusions For relatively small ureteral stones < 6 mm, analgesic treatment combined with naftopidil would be the first choice. However, for relatively large ureteral stones > 6 mm, it appears that analgesia is sufficient for initial treatment of ureteral stone.

To determine and evaluate the value of shadowing and the twinkling artifact (TA) for the diagnosis of ureteral stones.Related ultrasound images from 117 patients with suspected ureteral stones were consecutively collected with optimized machine settings, confirmed by computed tomography and then retrospectively reviewed by 12 physicians who were classified into 3 groups according to their experience levels: elementary, intermediate, and advanced. The shadowing/TA grades were separately evaluated by all the participating physicians in a blinded manner, and the consistency was verified using Kendall's coefficient of concordance (Kendall's W). Furthermore, the diagnostic performance was compared among the groups stratified by physicians' clinical experience levels and ureteral stone sizes.Using shadowing/TA as indicators for ureteral stones, Kendall's W for the TA evaluation was higher than that for shadowing among all the participating physicians and subgroups (P.05). Furthermore, with no difference in specificity at 100%, the sensitivity of the isolated TA was superior to that of shadowing in groups stratified by the physicians' clinical experience levels and stone sizes, respectively (P.05). However, for the respective comparisons of shadowing and the TA among groups stratified by stone sizes, as ureteral stones became larger, the detection sensitivities all significantly increased (P ≤.001).Among physicians, subjective evaluation of the TA is more consistent and has better diagnostic sensitivity than that of shadowing for the diagnosis of ureteral stones, and the stone size may play an important role in the detection sensitivity of these 2 indicators.

Giant ureteral calculi are defined as stones greater than 5 cm in length or circumference. These giant calculi can cause blockage of the ureter, dilation of the kidney and also decreased kidney function if not treated in time. The patient in this report presented with complaints of bilateral episodic pain of the bilateral lumbar region. Kidney, ureter and bladder (KUB) X-ray test showed a large bilateral ureteral stone about 14 cm in length and 106 g weight in the left ureter and 3 cm longitudinal diameter in the right ureter and also a staghorn stone in the left upper collecting system. Thereafter, the ureteric calculi were managed successfully using the combination of open and endoscopic techniques.

Objective: Ureteral stones are monitored for spontaneous passage in cases where there is no indication of interventional treatment. In this prospective study, we aimed to investigate the role of biochemical inflammation factors in predicting spontaneous passage. Methods: Our study was conducted in patients who presented with ureteral stones between August and November 2016, following ethics committee approval and patient consent. The inflammatory markers [white blood cell (WBC), C-reactive protein, sedimentation, mean platelet volume, neutrophil/lymphocyte ratio, procalcitonin in serum; WBC and bacteria in urine] were recorded in 54 patients with 5-10 mm single ureteral Stones and no indication for interventional treatment, and a control group of 33 volunteers with the same socio-demographic conditions. Medical expulsive therapy was applied to the case group and followed for 4 weeks. At the end of the follow-up, the case group was divided into two groups as passage (+) and passage (-). The groups’ data were compared statistically. Results: Distal localization (70% vs 37.5%; p

Transurethral double J (DJ) stent placement is a standard method for drainage during ureteral obstruction caused by a ureteral stone and for the management of complications after transurethral ureterolithotripsy (TUL). This is a safe and minimally invasive technique; however, severe cases of DJ stent migration have been reported, although rarely. Herein, we report the CASE of a 48-year-old man with DJ stent migration as renal penetration, which arose as a complication after an unsuccessful TUL. As transurethral DJ stent placement is one of the basic techniques performed by urologists, possible rare complications of the placement should be taken into consideration.

Objective: In this case report, we aimed to present our clinical experience in a patient with hydronephrotic and atrophic kidney due to impacted lower ureteral stone. Case description: A 56-year-old male was admitted to our emergency department with flank pain and nausea. A computed tomography scan revealed a 3 cm stone at the distal ureter, causing severe hydroureteronephrosis. Right kidney parenchyma was extremely thin at the medial zone, and some parenchyma was apparent at the upper and lower poles. We planned renal scintigraphy, but it was impossible to perform quickly due to the active appointment list. The patient’s kidney was assumed to be atrophic/non-functioning; however, given the long waiting list for renal scintigraphy and the patient’s intractable pain, we decided to relieve the patient’s pain with urinary drainage. Nephrostomy insertion was denied because of the extra thin parenchyma. About 40 days later, the patient underwent semi-rigid ureterorenoscopy under spinal anesthesia. It was impossible to place a double J stent to the ureter because of the kinked and extremely dilated ureter. So, we decided to place an open-end 6Fr ureter catheter. DMSA renal scintigraphy showed 33% right kidney and 67% left kidney function. Conclusion: Intractable flank pain might be a predictor of functioning renal parenchyma in hydronephrotic/atrophic kidneys. Renal split function lower than 10% on DMSA scintigraphy might not be an absolute indication of nephrectomy, especially in the obstructed renal unit. Evaluation of renal function after eliminating obstruction might be more reliable.

Few studies have compared renal infarction (RI) and ureteral stone (US), so there is insufficient evidence for emergency clinicians (ECs) to quickly suspect RI during the first assessment. Therefore, we compared the initial clinical presentation and laboratory findings of these diseases in the emergency department (ED) to determine a factor that may indicate RI.This single-center retrospective case-control study included 42 patients with acute RI and 210 with US who visited the ED from 2014 to 2020. Medical record data from first ED arrival were investigated, and clinical presentations, blood and urine test results obtained in the ED were compared and analyzed using logistic regression analysis.ECs never suspected the initial diagnosis of RI as RI. The most common initial diagnosis was US (40.5%). Among patients with US, 150 patients (71.4%) were suspected of having US (p 0.001). Abdominal pain (61.9%) was the most common chief complaint in the RI group, and flank pain (73.8%) was the most common in the US group (p 0.001). 27 factors showed significant differences between the groups. Among those, age ≥ 70 years (odds ratio [OR]: 311.2, 95% confidence interval [CI]: 2.0-47,833.1), history of A-fib (OR: 149872.8, 95% CI: 289.4-7.8E+07), fever ≥37.5 °C (OR: 297.3, 95% CI: 3.3-27,117.8), ClWhen differentiating acute RI from US in the ED, age ≥ 70 years, history of A-fib, fever ≥37.5 °C, LDH ≥500 IU/L, Cl

Background One of the underlying reasons for shock wave lithotripsy (SWL)-resistance is the ureteral stone's impaction. This study aimed to investigate the accuracy of the hypothesis, suggesting that SWL per se can be the reason for ureteral stone impaction. Methods One hundred and seventy-six patients were enrolled in the study. Data of the patients (n=50) treated with SWL and subsequent semirigid ureteroscopic laser lithotripsy (SULL) in our center between January 2014 and January 2020 were retrospectively reviewed compared with the data of the patients (n=126) who underwent SULL without prior SWL treatment during the same period. Patients reported to have ureteral stone impaction during SULL were compared with those without stone impaction in terms of demographic parameters, stone characteristics, and clinical data, including symptom duration and presence or absence of SWL history. Results The success rate of SULL was determined as 80.1% (141/176). Univariable analysis revealed statistically significant differences between the patients with and without stone impaction concerning stone diameter, stone volume, pre-SULL SWL history, symptom duration, and ureteral wall thickness (UWT). Multivariable logistic regression analysis revealed that symptom duration and UWT were independent predictive factors for ureteral stone impaction. Conclusions Symptom duration and UWT are independent predictors of ureteral stone impaction. Symptom duration and UWT should be considered during treatment planning and informed consent process before proceeding with SULL.

Amaç: Üreteroskopi esnasında üreter duvarında oluşan hasarı sınıflandırmak için Post-Üreteroskopik Lezyon Skalası (PULS) kullanılmaktadır. Bu çalışmada PULS derecelerine göre absorbe edilen irrigasyon sıvı hacimlerinin ön sonuçlarını sunduk. Gereç ve Yöntemler: Bu çalışmaya üreter taşı nedeniyle 7 F semirijid üreteroskopi uygulanan 44 hasta dahil edildi. Tüm hastalara genel anestezi uygulandı. %1 etanol içeren izotonik irrigasyon sıvısı olarak kullanıldı. Venöz kan etanol konsantrasyonları irrigasyon kullanılmaya başlaması ile ölçülmeye başlandı, operasyon sonrası derlenme odasını kapsayacak şekilde 15 dakika arayla periyodik ölçüldü. Absorbe edilen sıvı hacmi kan etanol konsantrasyonları kullanılarak hesaplandı. İrrigasyon süresi, taş boyutu, PULS derecesi kaydedildi.Bulgular: Ortalama operasyon süresi 44.2 ± 19.9 dakika olarak saptandı. Ortalama taş hacmi 12.7± 6 mm ve ortalama kullanılan irrigasyon sıvı miktarı 1371±1262 mL olarak ölçüldü. Hastaların 26’sınde PULS derecesi 0 iken 18’inde 1 veya üzerindeydi üzerindeydi. Hiçbir hastada PULS derecesi 3 veya 4 olmadı. Ortalama absorbe edilen sıvı hacmi 58 ± 50,6 mL olarak hesaplandı. PULS derecesi ile ortalama absorbe edilen sıvı miktarı arasında istatistiksel anlamlı fark saptanmadı.Sonuç: Çalışmamızın ön sonuçlarında üreteral duvarda perforasyon olmayan hastalarda absorbe edilen sıvı miktarının artmadığı gösterilmiştir., Objective: Post-Ureteroscopic Lesion Scale (PULS) is used to classify ureteral wall injury that occurs during ureteroscopy. In this study we presented the preliminary results of absorbed irrigation fluid volumes according to PULS grades.Material and Methods: Forty-four patients to whom 7F semirigid ureteoscopy was performed due to ureteral stone were included in the study. All patients received general anesthesia. Izotonic containing 1% ethanol was used as irrigation fluid. Ethanol concentration in venous blood was commenced to be measured at the start of irrigation use and was carried on at 15-minute intervals including the post-operative period in the recovery room. Absorbed fluid volume was calculated by using blood ethanol concentrations. Irrigation time, stone size and PULS grade were recorded. Results: Mean operation time was found to be 44.2 ± 19.9 minutes. Mean stone size was measured to be 12.7± 6 mm and mean irrigation fluid amount used was 1371±1262 ml. PULS grade of 0 was seen in 26 patients and that of 1 or more was seen in 18 patients. No patient had a PULS grade of 3 or 4. Mean absorbed fluid volume was measured to be 58 ± 50,6 ml. No significant correlation was found between PULS grade and mean absorbed fluid volume. Conclusion: Fluid absorption during URS is not correlated with the PULS grade. Semirigid URS is a safe treatment option for ureteral stone disease in terms of the level of irrigation fluid being absorbed.

Objective In this study, we aimed to contribute to the literature by sharing and evaluating the clinical characteristics and our treatment and follow‐up approaches in patients in the COVID‐19 positive treatment process who had presented to our hospital's emergency department with a distal ureteral stone and to examine the effects of the pandemic and disease in this group of patients. Method The study included 14 patients infected with COVID‐19 who had presented to the Erzurum City Hospital Emergency Department between August 2020 and December 2020 with the complaint of renal colic in which distal ureteral stones were detected in the tests. The demographic and clinical characteristics of patients, laboratory and radiological examinations, characteristics of ureteral stones, details of treatments applied to patients, treatment procedures of patients who had undergone surgical treatment, patient files, visit and operation notes and the patient discharge reports were retrospectively reviewed and evaluated. Results The study included 14 patients. The average age of the patients was 35.7 (±14.35). The average stone size was 6.2 (±1.8) mm. Analgesic treatment and MET for distal ureteral stones were begun in 11 (78.6%) of the patients. Pain control was achieved in nine patients (64.2%) with analgesic treatment and MET, and the stone was removed without invasive intervention. Surgical intervention was performed in a total of five patients (35.7%). Conclusion In most COVID‐19 infected patients with renal colic and a distal ureteral stone, results can be obtained using MET. Patients with a distal ureteral stone and persistent renal colic can be safely and effectively treated by endoscopic ureteral stone treatment after taking necessary precautions. Prospective, randomised, and controlled studies are required on this subject.

The patient in this case is a 76-year-old male who was admitted to the ER two weeks prior and was found to have an obstructing, 1-cm left proximal ureteral stone with a forniceal rupture. A left ureteral stent was placed, and he was started on antibiotics. In this video, Dr. Ryan Hankins at MedStar Georgetown University Hospital performs definitive management of the stone with a left ureteroscopy, laser lithotripsy, and stent replacement.

Background: Ureteral obstruction is a common surgical problem and managed by stent insertion or percutaneous nephrostomy. However, there is still confusion that which procedure is better in terms of the complications. Objective: To compare the efficacy of double J stenting and percutaneous nephrostomy for ureteral obstruction in terms of post-operative complications. Study Design: Randomized Clinical Trial. Settings: Urology Department, Shaikh Zayed Hospital, Rahim Yar Khan-Pakistan. Duration: One years from January through December 2016. Methodology: Male/female patients (aged: 19-63 years) presenting in the OPD of the hospital with ureteral obstruction were registered during study period. Either of the groups i.e. A (double J stenting, n = 55) or B (percutaneous nephrostomy, n = 55) was allotted to the subjects, randomly. The procedures and subsequent complications were addressed as per hospital protocols. Results: Most of the patients i.e., 75 (68.2% of 110) were male whereas age statistics were, as: M = 49.47, SD = 8.2 (range 19-62) years. Ureteral stone(s) was found as the most prevalent cause of ureteral obstruction in group A (49.1%, n = 27) and B (40.0%, n = 22). Hematuria was seen as a common complication: 33.3 (n = 5) and 42.9% (n = 3) in group A and B, respectively. The rate of complications was significantly lower in group B than A [12.7% (n = 7) vs. 27.3% (n = 15), respectively] (p = .04). Conclusion: Percutaneous nephrostomy is a better procedure (in terms of post-operative complications) than double J stenting in management of ureteral obstruction. Keywords: Ureteral obstruction, Percutaneous nephrostomy, Stents, Postoperative complication.