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Aksakalli T, Aksakalli IK, Cinislioglu AE, Utlu A, Demirdogen SO, Celik F, Karabulut I. Prediction of spontaneous distal ureteral stone passage using artificial intelligence. Int Urol Nephrol 2024; 56:2179-2186. [PMID: 38340263 DOI: 10.1007/s11255-024-03955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/06/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE Identifying factors predicting the spontaneous passage of distal ureteral stones and evaluating the effectiveness of artificial intelligence in prediction. MATERIALS AND METHODS The files of patients presenting with distal ureteral stones were retrospectively evaluated. Those who experienced spontaneous passage were assigned to Group P, while those who did not were assigned to Group N. Demographic and clinical data of both groups were compared. Then, logistic regression analysis was performed to determine the factors predicting spontaneous stone passage. Based on these factors, a logistic regression model was prepared, and artificial intelligence algorithms trained on the dataset were compared with this model to evaluate the effectiveness of artificial intelligence in predicting spontaneous stone passage. RESULTS When comparing stone characteristics and NCCT findings, it was found that the stone size was significantly smaller in Group P (4.9 ± 1.7 mm vs. 6.8 ± 1.4 mm), while the ureteral diameter was significantly higher in Group P (3.3 ± 0.9 mm vs. 3.1 ± 1.1 mm) (p < 0.05). Parameters such as stone HU, stone radiopacity, renal pelvis AP diameter, and perirenal stranding were similar between the groups. In multivariate analysis, stone size and alpha-blocker usage were significant factors in predicting spontaneous stone passage. The ROC analysis for the logistic regression model constructed from the significant variables revealed an area under the curve (AUC) of 0.835, with sensitivity of 80.1% and specificity of 68.4%. AI algorithms predicted the spontaneous stone passage up to 92% sensitivity and up to 86% specifity. CONCLUSIONS AI algorithms are high-powered alternatives that can be used in the prediction of spontaneous distal ureteral stone passage.
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Affiliation(s)
- Tugay Aksakalli
- Department of Urology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey.
| | | | | | - Adem Utlu
- Department of Urology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | | | - Feyzullah Celik
- Department of Urology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ibrahim Karabulut
- Department of Urology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Pérez-Aizpurua X, Cabello Benavente R, Bueno Serrano G, Alcázar Peral JM, Gómez-Jordana Mañas B, Tufet i Jaumot J, Ruiz de Castroviejo Blanco J, Osorio Ospina F, Gonzalez-Enguita C. Obstructive uropathy: Overview of the pathogenesis, etiology and management of a prevalent cause of acute kidney injury. World J Nephrol 2024; 13:93322. [DOI: 10.5527/wjn.v13.i2.93322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/24/2024] [Accepted: 06/18/2024] [Indexed: 06/25/2024] Open
Abstract
Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary tract. It is regarded as one of the most prevalent causes of acute kidney injury (AKI), accounting for 5%–10% of cases. Acute severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve obstruction. The aim of the present article is to review and synthesize available evidence on obstructive uropathy, providing a clinical guideline for clinicians. A literature review on obstructive uropathy in the context of AKI was performed, focusing on the least clarified aspects regarding diagnosis and management. Recent literature searching was conducted in English and top-level evidence articles including systematic reviews, metanalyses and large series were prioritized. Acute obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the kidney. Early recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection. A multidisciplinary approach, including urologists, nephrologists, and other medical specialties, is best suited to correctly manage concomitant hemodynamic changes, fluid and electrolyte imbalances, and other related issues. Obstructive uropathy is one of the leading causes of AKI. Recognition of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challenging. A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.
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Affiliation(s)
- Xabier Pérez-Aizpurua
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | - Ramiro Cabello Benavente
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | - Gonzalo Bueno Serrano
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | - José María Alcázar Peral
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | | | - Jaime Tufet i Jaumot
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | | | - Felipe Osorio Ospina
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
| | - Carmen Gonzalez-Enguita
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid 28015, Madrid, Spain
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Alwan MG, Nima MH, Alquraishi FS, Rashid NR. Deciding on a novel predictive value to gauge how well patients with lower ureteric stones respond to medical expulsive therapy. Urolithiasis 2024; 52:41. [PMID: 38441660 DOI: 10.1007/s00240-024-01549-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
This study, conducted over 4 years in Baghdad, Iraq, aimed to determine the importance of ureteric jet assessment in medical expulsive therapy (MET) for distal ureteral stones. A total of 156 patients with distal ureteral stones (≤ 10 mm) participated, and their ureteric jets were observed using a color Doppler scanner before and after 2 weeks of MET. The main focus was the success rate of stone expulsion. Our results showed that 50% of patients had detectable ureteric jets after 2 weeks of MET, and 21.8% experienced successful stone expulsion. After 4 weeks, 23.7% achieved stone expulsion, while 54.5% still had remaining stones. Patients who had a positive baseline ureteric jet were significantly more likely to successfully expel their stones. This study highlights the importance of monitoring ureteric jet movement in MET for distal ureteral stones.
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Affiliation(s)
| | | | | | - Najah Raham Rashid
- Ibn Sina University for Medical and Pharmaceutical Sciences, Baghdad, Iraq
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Wang XZ, Liu CZ, Wang LQ, Qu ZC, Cao Y, Yan SY, Yang JW, Tu JF. Acupuncture for response and complete pain relief time of acute renal colic: Secondary analysis of a randomized controlled trial. Integr Med Res 2024; 13:101021. [PMID: 38379605 PMCID: PMC10876610 DOI: 10.1016/j.imr.2024.101021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Background The integration of acupuncture with intramuscular injection of diclofenac sodium can expedite the onset of analgesia in treating acute renal colic caused by urolithiasis. However, it remains unclear whether acupuncture can accelerate pain relief constantly until complete remission. This study aimed to explore the extent to which acupuncture can expedite the onset time of response or complete pain relief in treating acute renal colic, and the predictive value of patient characteristics for treatment efficacy. Methods This secondary analysis utilized data from a prior randomized controlled trial. Eighty patients with acute renal colic were randomly assigned 1:1 to the acupuncture group or the sham acupuncture group. After intramuscular injection of diclofenac sodium, acupuncture or sham acupuncture was delivered to patients. The outcomes included time to response (at least a 50 % reduction in pain) and complete pain relief. Between-group comparison under the 2 events was estimated by Kaplan-Meier methodology. Subgroup analysis was performed utilizing the Cox proportional hazards model. Results The median response time and complete pain relief time in the acupuncture group were lower than those in the sham acupuncture group (5 vs 30 min, Log Rank P < 0.001; 20 min vs not observed, Log Rank P < 0.001, respectively). Hazard Ratios (HRs) for response across all subgroups favored the acupuncture group. All HRs for complete pain relief favored acupuncture, expect large stone and moderate pain at baseline. No interaction was found in either event. Conclusion Acupuncture can accelerate the response time and complete pain relief time for patients with acute renal colic, with the efficacy universally. Trial registration This study has been registered at Chinese Clinical Trial Registry: ChiCTR1900025202.
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Affiliation(s)
- Xue-Zhou Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Qiong Wang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Zhi-Cheng Qu
- Emergency Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Ying Cao
- Emergency Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Shi-Yan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Wen Yang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jian-Feng Tu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Akram M, Jahrreiss V, Skolarikos A, Geraghty R, Tzelves L, Emilliani E, Davis NF, Somani BK. Urological Guidelines for Kidney Stones: Overview and Comprehensive Update. J Clin Med 2024; 13:1114. [PMID: 38398427 PMCID: PMC10889283 DOI: 10.3390/jcm13041114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Evidence-based guidelines are published by urological organisations for various conditions, including urolithiasis. In this paper, we provide guidance on the management of kidney stone disease (KSD) and compare the American Urological Association (AUA) and European Association of Urologists (EAU) guidelines. METHODS We evaluate and appraise the evidence and grade of recommendation provided by the AUA and EAU guidelines on urolithiasis (both surgical and medical management). RESULTS Both the AUA and EAU guidelines provide guidance on the type of imaging, treatment options, and medical therapies and advice on specific patient groups, such as in paediatrics and pregnancy. While the guidelines are generally aligned and based on evidence, some subtle differences exist in the recommendations, but both are generally unanimous for the majority of the principles of management. CONCLUSIONS We recommend that the guidelines should undergo regular updates based on recently published material, and while these guidelines provide a framework, treatment plans should still be personalised, respecting patient preferences, surgical expertise, and various other individual factors, to offer the best outcome for kidney stone patients.
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Affiliation(s)
- Mahir Akram
- Core Trainee in Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.A.)
| | - Victoria Jahrreiss
- Core Trainee in Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.A.)
| | | | | | - Lazaros Tzelves
- Faculty of urology, University of Athens, 15772 Athens, Greece (L.T.)
| | | | | | - Bhaskar K. Somani
- Core Trainee in Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; (M.A.)
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Prezioso D, Piccinocchi G, Abate V, Ancona M, Celia A, De Luca C, Ferrari R, Ferraro PM, Mancon S, Mazzon G, Micali S, Puca G, Rendina D, Saita A, Salvetti A, Spasiano A, Tesè E, Trinchieri A. The role of the general practictioner in the management of urinary calculi. Arch Ital Urol Androl 2023; 95:12155. [PMID: 38193217 DOI: 10.4081/aiua.2023.12155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The prevalence of kidney stones tends to increase worldwide due to dietary and climate changes. Disease management involves a high consumption of healthcare system resources which can be reduced with primary prevention measures and prophylaxis of recurrences. In this field, collaboration between general practitioners (GPs) and hospitals is crucial. METHODS a panel composed of general practitioners and academic and hospital clinicians expert in the treatment of urinary stones met with the aim of identifying the activities that require the participation of the GP in the management process of the kidney stone patient. RESULTS Collaboration between GP and hospital was found crucial in the treatment of renal colic and its infectious complications, expulsive treatment of ureteral stones, chemolysis of uric acid stones, long-term follow-up after active treatment of urinary stones, prevention of recurrence and primary prevention in the general population. CONCLUSIONS The role of the GP is crucial in the management and prevention of urinary stones. Community hospitals which are normally led by GPs in liaison with consultants and other health professional can have a role in assisting multidisciplinary working as extended primary care.
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Affiliation(s)
- Domenico Prezioso
- Dipartimento Neuroscienze, Scienze della Riproduzione ed Odontostomatologia Università Federico II, Naples.
| | | | - Veronica Abate
- Department of Clinical Medicine and Surgery, Federico II University, Naples.
| | | | - Antonio Celia
- S.C. Urologia ULSS 7 Pedemontana, Bassano del Grappa (VI).
| | - Ciro De Luca
- Dipartimento Neuroscienze, Scienze della Riproduzione ed Odontostomatologia Università Federico II, Naples.
| | - Riccardo Ferrari
- Department of Urology, University of Modena and Reggio Emilia, Baggiovara (MO).
| | - Pietro Manuel Ferraro
- Sezione di Nefrologia, Dipartimento di Medicina, Università degli Studi di Verona, Verona.
| | - Stefano Mancon
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan.
| | - Giorgio Mazzon
- S.C. Urologia ULSS 7 Pedemontana, Bassano del Grappa (VI).
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Baggiovara (MO).
| | - Giacomo Puca
- Dipartimento Neuroscienze, Scienze della Riproduzione ed Odontostomatologia Università Federico II, Naples.
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, Federico II University, Naples.
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan.
| | | | | | - Elisa Tesè
- Società Italiana di Medicina Generale, Florence.
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Wang Z, Chi J, Liu Y, Wu J, Cui Y, Yang C. Efficacy of mirabegron for ureteral stones: a systematic review with meta-analysis of randomized controlled trials. Front Pharmacol 2023; 14:1326600. [PMID: 38178860 PMCID: PMC10765542 DOI: 10.3389/fphar.2023.1326600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Background: Medical expulsive therapy demonstrates efficacy in managing ureteral stones in patients amenable to conservative interventions. This meta-analysis aims to evaluate the effectiveness of mirabegron in the treatment of ureteral stones. Methods: From conception to November 2023, we examined PubMed databases, the Cochrane Library, Embase, Ovid, Scopus, and trial registries for this systematic review and meta-analysis. We chose relevant randomized controlled trials (RCTs) evaluating the efficacy of mirabegron as an expulsive treatment for ureteral stones. The Cochrane risk of bias method was used to assess the quality of the evidence. Outcome measures, which included the stone expulsion rate (SER), expulsion time, and pain episodes, were analyzed using RevMan 5.4 and Stata 17. Results: Seven RCTs (N = 701) had enough information and were ultimately included. In patients with ureteral stones, mirabegron-treated patients had a substantially higher SER [odds ratio (OR) = 2.57, 95% confidence interval (CI) = 1.41-4.68, p = 0.002] than placebo-treated patients. Subgroup analysis revealed that mirabegron was superior to placebo in patients with small ureteral stones (OR = 2.26, 95% CI = 1.05-4.87, p = 0.04), with no heterogeneity between studies (p = 0.54; I2 = 0%). Mirabegron patients had a higher SER than the control group for distal ureteral stones (DUSs) (OR = 2.48, 95% CI = 1.31-4.68, p = 0.005). However, there was no difference in stone ejection time or pain episodes between groups. Conclusion: Mirabegron considerably improves SER in patients with ureteral stones, and the effect appears to be more pronounced for small and DUSs. Nevertheless, mirabegron treatment was not associated with improved stone expulsion time or pain management.
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Affiliation(s)
- Zhenguo Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Junpeng Chi
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yuhua Liu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Jitao Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Chenchen Yang
- Department of Urology, Tengzhou Central People’s Hospital, Tengzhou, China
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Almeras C, Meria P. 2022 Recommendations of the AFU Lithiasis Committee: Summary of indications. Prog Urol 2023; 33:901-910. [PMID: 37918991 DOI: 10.1016/j.purol.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The spontaneous elimination rate of ureteral stones decreases with their size, but also in function of their location. The objectives of stone surveillance are to detect the occurrence of a complication (e.g., fever, clinical tolerance) and to verify the potential stone migration/elimination. The use of urological procedures and the choice of technique are based on many different factors. Kidney stone surveillance is proposed mainly to people with low risk of progression or complications (size<4mm and/or lower calyx location and non-infection stone). Surveillance may be extended to patients with larger stones, in function of the clinical context and comorbidities. Conversely, a urological procedure may also be proposed to patients with stones<4mm for professional (e.g., soldier, pilot, expatriate) or social reasons or if travelling is planned. The choice of technique is based on the stone composition (if already known) and density, the advantages and limitations of each technique, and also the clinical context, while trying to choose the least invasive procedure for a stone-free objective. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations method (CPR) and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU 2022] and their adaptability to the French context. This chapter is based on the references used in the chapters on the different techniques (extracorporeal shock wave therapy, ureteroscopy, percutaneous nephrolithotomy, medical expulsive therapy, postural therapy, chemolysis by alkalinization) as well as the American Urological Association (AUA) and EAU recommendations.
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Affiliation(s)
- C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP, centre université Paris Cité, Paris, France
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Hartung FO, Müller KJ, Herrmann J, Grüne B, Michel MS, Rassweiler-Seyfried MC. Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL). Urolithiasis 2023; 51:120. [PMID: 37801124 PMCID: PMC10558392 DOI: 10.1007/s00240-023-01495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
This study is aimed to determine whether postoperative low dose computed tomography (LDCT) imaging is necessary after percutaneous nephrolithotomy (PCNL), or the surgeon's intraoperative assessment of residual fragments (RF) is sufficient and avoidance of postoperative imaging with reduction of radiation exposure can be achieved. Data of all 610 patients who underwent PCNL in prone position in our institution from February 2009 to September 2020 was collected. Parameters such as age, gender, BMI, ASA-Classification, stone related parameters and the surgeon's assessment of stone-free status were analyzed. The LDCT performed postoperatively was compared to the intraoperative assessment of the surgeon regarding RF. The mean age of patients was 52.82 years; the mean BMI was 28.18 kg/m2. In 418 cases, the surgeon made a clear statement about the presence of RF and postoperative LDCT was carried out. The discrepancy between the two methods (surgeon´s assessment vs. LDCT) was significant at p < 0.0001. The sensitivity, specificity, positive and negative predictive value of the surgeon when assessing RF were 24.05%, 99.45%, 98.28% and 50%. Stone free rate (SFR) after primary PCNL was 45.57%. The overall SFR at discharge was 96.23%. Although the surgeon´s assessment of RF was reliable, postoperative LDCT imaging should still be performed if endoscopic stone clearance is suspected due to the high false negative rate and the low negative predictive value. The optimal timing of postoperative imaging following PCNL remains unclear.
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Affiliation(s)
- F. O. Hartung
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - K. J. Müller
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - J. Herrmann
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - B. Grüne
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - M. S. Michel
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - M. C. Rassweiler-Seyfried
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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10
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Pandey A, Mandal S, Kumaraswamy S, Gaur AS, Das MK, Nayak P. A prospective evaluation of patient-reported outcomes during follow-up of ureteral stones managed with medical expulsive treatment (MET). Urolithiasis 2023; 51:56. [PMID: 36943497 DOI: 10.1007/s00240-023-01428-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
Patient-reported outcomes (PROs) for ureteral stones predominantly assess the pain. Despite the lack of evidence, multiple trials studying the efficacy of medical expulsive therapy (MET) have used PROs to define spontaneous stone passage (SSP). We aim to objectively evaluate the accuracy of PROs to predict successful SSP and the probability of patient's symptom resolution after stone passage. A single-center, prospective observational study recruiting adults with isolated, uncomplicated, ≤ 10 mm ureteral calculus was conducted. All patients received 4 weeks of MET, and SSP was confirmed by low-dose non-contrast-enhanced computed tomography (NCCT). The accuracy of PROs: "pain cessation," "decreased pain," "stone seen," and "stone capture" to predict successful SSP were evaluated in 1 month. The patient's symptom resolution rate was assessed at 1 and 4-month follow-ups. A total of 171 patients were included, and the overall SSP rate was 66.4% (n = 99). Patient-reported pain cessation, stone visualization, and stone capture were associated with successful SSP, but their accuracy was 59, 53, and 43%, respectively. Moreover, 25% of patients reporting complete pain cessation still harbored ureteral calculus. Pain resolved in 91% of patients after SSP at a 4-month follow-up. While hematuria and nausea resolved in all patients, lower urinary tract symptoms (LUTS) were not resolved in 17% of patients. We concluded that patient-reported pain cessation, stone visualization, and stone capture predict successful SSP, but confirmatory imaging is required due to the poor accuracy of these measures. The significant rates of non-pain-related symptoms indicate their significant contribution to patient morbidity. Clinical Trial Registration: Registered in Clinical Trial Registry of India (CTRI), Registration number: CTRI/2020/10/028777 (29th October 2020).
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Affiliation(s)
- Abhishek Pandey
- Department of Urology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Swarnendu Mandal
- Department of Urology, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Santosh Kumaraswamy
- Department of Urology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Abhay Singh Gaur
- Department of Urology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manoj K Das
- Department of Urology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Prasant Nayak
- Department of Urology, All India Institute of Medical Sciences, Bhubaneswar, India
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Atan A, Turkyilmaz Z, Karabulut R, Sonmez K. Comment on: Management of pediatric ureterolithiasis in the emergency room: A single institution review and new management pathway. J Pediatr Urol 2023:S1477-5131(23)00064-5. [PMID: 36890023 DOI: 10.1016/j.jpurol.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Ali Atan
- Gazi University, Faculty of Medicine, Departments of Urology, Ankara, Turkey
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12
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Boeykens M, Van Haute C, De Coninck V. RE: Removal of small, asymptomatic kidney stones and incidence of relapse. World J Urol 2023; 41:613-614. [PMID: 36571592 DOI: 10.1007/s00345-022-04251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Matthias Boeykens
- Department of Urology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carl Van Haute
- Department of Urology, KU Leuven, Katholieke Universiteit Leuven, University Hospitals Leuven, Louvain, Belgium
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13
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Ok F, Durmuş E. External Validation of CHOKAI and STONE Scores for Detecting Ureter Stones in the Eastern Turkish Population. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2022.2022.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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14
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Wentz A, Wang R, Marshall B, Shireman T, Liu T, Merchant R. Opioid Analgesic Use After an Acute Pain Visit: Evidence from a Urolithiasis Patient Cohort. West J Emerg Med 2022; 23:864-871. [DOI: 10.5811/westjem.2022.8.56679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/13/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Urolithiasis causes severe acute pain and is commonly treated with opioid analgesics in the emergency department (ED). We examined opioid analgesic use after episodes of acute pain.
Methods: Using data from a longitudinal trial of ED patients with urolithiasis, we constructed multivariable models to estimate the adjusted probability of opioid analgesic use 3, 7, 30, and 90 days after ED discharge. We used multiple imputation to account for missing data and weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge. We used weighted multivariable regression to compare longitudinal opioid analgesic use for those prescribed vs not prescribed an opioid analgesic at discharge, stratified by reported pain at ED discharge.
Results: Among 892 adult ED patients with urolithiasis, 79% were prescribed an opioid analgesic at ED discharge. Regardless of reporting pain at ED discharge, those who were prescribed an opioid analgesic were significantly more likely to report using it one, three, and seven days after the visit in weighted multivariable analysis. Among those who were not prescribed an opioid analgesic, an estimated 21% (not reporting pain at ED discharge) and 30% (reporting pain at discharge) reported opioid analgesic use at day three. Among those prescribed an opioid analgesic, 49% (no pain at discharge) and 52% (with pain at discharge) reported using an opioid analgesic at day three.
Conclusion: Urolithiasis patients who received an opioid analgesic at ED discharge were more likely to continue using an opioid analgesic than those who did not receive a prescription at the initial visit, despite the time-limited nature of urolithiasis.
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Affiliation(s)
- Anna Wentz
- Brown University School of Public Health, Department of Epidemiology, Providence, Rhode Island
| | - Ralph Wang
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Brandon Marshall
- Brown University School of Public Health, Department of Epidemiology, Providence, Rhode Island
| | - Theresa Shireman
- Brown University School of Public Health, Health Services Policy & Practice, Providence, Rhode Island
| | - Tao Liu
- Brown University School of Public Health, Data & Statistics Core of Brown Alcohol Research Center on HIV (ARCH), Providence, Rhode Island
| | - Roland Merchant
- Harvard Medical School, Brigham and Women’s Hospital Department of Emergency Medicine, Boston, Massachusetts
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15
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Haifler M, Kleinmann N, Haramaty R, Zilberman DE. A machine learning model for predicting surgical intervention in renal colic due to ureteral stone(s) < 5 mm. Sci Rep 2022; 12:11788. [PMID: 35821517 PMCID: PMC9276693 DOI: 10.1038/s41598-022-16128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/05/2022] [Indexed: 11/09/2022] Open
Abstract
A 75-89% expulsion rate is reported for ureteric stones ≤ 5 mm. We explored which parameters predict justified surgical intervention in cases of pain caused by < 5 mm ureteral stones. We retrospectively reviewed all patients with renal colic caused by ureteral stone < 5 mm admitted to our urology department between 2016 and 2021. Data on age, sex, body mass index, the presence of associated hydronephrosis/stranding on images, ureteral side, stone location, medical history, serum blood count, creatinine, C-reactive protein, and vital signs were obtained upon admission. XGboost (XG), a machine learning model has been implemented to predict the need for intervention. A total of 471 patients (median age 49, 83% males) were reviewed. 74% of the stones were located in the distal ureter. 160 (34%) patients who sustained persistent pain underwent surgical intervention. The operated patients had proximal stone location (56% vs. 10%, p < 0.001) larger stones (4 mm vs. 3 mm, p < 0.001), longer length of stay (3.5 vs. 3 days, p < 0.001) and more emergency-room (ER) visits prior to index admission (2 vs. 1, p = 0.007) compared to those who had no surgical intervention. The model accuracy was 0.8. Larger stone size and proximal location were the most important features in predicting the need for intervention. Altogether with pulse and ER visits, they contributed 73% of the final prediction for each patient. Although a high expulsion rate is expected for ureteral stones < 5 mm, some may be painful and drawn out in spontaneous passage. Decision-making for surgical intervention can be facilitated by the use of the present prediction model.
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Affiliation(s)
- Miki Haifler
- Department of Urology, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel.,Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel.,Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rennen Haramaty
- Department of Urology, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel.,Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel. .,Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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16
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Wagenius M, Oddason K, Utter M, Popiolek M, Forsvall A, Lundström KJ, Linder A. Factors influencing stone-free rate of Extracorporeal Shock Wave Lithotripsy (ESWL); a cohort study. Scand J Urol 2022; 56:237-243. [DOI: 10.1080/21681805.2022.2055137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Magnus Wagenius
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Karl Oddason
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Maria Utter
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Marcin Popiolek
- Department or Urology, Örebro University Hospital, Örebro, Sweden
| | - Andreas Forsvall
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Karl-Johan Lundström
- Institution of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Adam Linder
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
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17
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[Follow-up after urolithiasis management]. Urologe A 2022; 61:500-507. [PMID: 35381865 PMCID: PMC9072455 DOI: 10.1007/s00120-022-01816-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Urinary stones often affect younger people. Because the risk of recurrence is high, regular follow-up is important for individuals at risk. OBJECTIVE To summarize the extent of urinary stones and the health and economic impact in the population; to provide recommendations for general and stone-specific follow-up. MATERIALS AND METHODS Analysis and discussion of publications and guideline recommendations. RESULTS The risk of recurrence after a stone attack can be high depending on the risk profile. An initial metabolic workup should be performed promptly after stone therapy. General dietary management should be intensified by stone-specific dietary management depending on the risk profile. Nutritional counseling may be helpful. Imaging after stone therapy is used to monitor the success of treatment and detect recurrences early. Since the risk of recurrence can vary greatly depending on the stone composition, not only the type of imaging but also its frequency should be adjusted accordingly. The same applies to the various stone therapies, which help determine the frequency and type of imaging follow-up. Exact guidelines and cost-effectiveness analyses of follow-up examinations after stone therapy are unfortunately missing. CONCLUSIONS Acute urolithiasis represents an excruciating experience for patients. Accordingly, their willingness to undergo metaphylaxis and follow-up shortly after the event is strong. Since the risk of recurrence after a stone attack can be very high, regular follow-up after stone therapy is essential. The frequency of follow-up should be adapted to the probability of stone recurrence.
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18
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Zhang X, Liu X, Ye Q, Wang X, Chen J, Wang Z, Zhao P, Tao B, Xu G, Xu W, Wu K, Xiao Y, Yang L, Tian J, Wang J, Dong Z, Wang Z. Acupuncture versus Lornoxicam in the Treatment of Acute Renal Colic: A Randomized Controlled Trial. J Pain Res 2021; 14:3637-3648. [PMID: 34876848 PMCID: PMC8643168 DOI: 10.2147/jpr.s339006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/13/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To compare the analgesic efficacy and safety of acupuncture and lornoxicam in acute renal colic (ARC). Design, Setting, Participant A randomized, double-blind, parallel-controlled, single-centered trial was conducted at Susong County People’s Hospital from October 2019 to November 2020. Eighty-four patients with ARC were randomly divided into lornoxicam group (Group L) and acupuncture group (Group A). Group A was treated with acupuncture at Sanyinjiao (SP6), Yinlingquan (SP9) and normal saline, and Group L was treated with sham acupuncture at SP6, SP9 and lornoxicam. Main Outcome Measures Visual analogue scale (VAS) scores and adverse reactions such as nausea and dizziness were recorded within 5, 10, 15, 20 and 40 minutes after treatment. The main outcome of this study was the short-term effective (STE) rate, the secondary outcome was the onset time, and the safety index was incidence of adverse reactions. Results A total of 80 patients completed this study, including 41 patients (21 males and 20 females) in Group L and 39 patients (21 males and 18 females) in Group A. Group A exhibited lower scores versus group L after treatment (P < 0.05). The overall STE of group L was 61.00% (25/41), significantly lower than group A [84.62% (33/39)] (P < 0.001). There was no difference in the incidence of adverse reactions between group A [2.6% (1/39)] and group L [7.3% (3/41)] (P = 0.616). The ordered logistic regression analysis showed patients receiving acupuncture therapy are more likely to be cured [OR = 2.887, 95% CI: (1.190, 7.000), P = 0.019]. Conclusion Acupuncture at SP6, SP9 and intramuscular injection of lornoxicam can effectively and safely relieve ARC, but the former has faster and better analgesic effect. Moreover, the incidence of adverse reactions was similar between the two treatments. This acupuncture therapy is recommended as a complementary therapy for ARC.
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Affiliation(s)
- Xiaohua Zhang
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
| | - Xinguo Liu
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Qiongxiang Ye
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Xunbao Wang
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Jinjun Chen
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Zhiyong Wang
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Pengfei Zhao
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Baozhou Tao
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Guoping Xu
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Wanfeng Xu
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Kan Wu
- Department of Urology, Susong County People's Hospital, Susong, Anhui Province, People's Republic of China
| | - Yao Xiao
- Department of Pediatrics, Lanzhou University Second Hospital, Lanzhou, Gansu Province, People's Republic of China
| | - Li Yang
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
| | - Junqiang Tian
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
| | - Juan Wang
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
| | - Zhilong Dong
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
| | - Zhiping Wang
- Institute of Urology, Lanzhou University Second Hospital; Key Laboratory of Gansu Province for Urological Diseases; Gansu Nephro-Urological Clinical Center, Lanzhou, Gansu Province, People's Republic of China
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19
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Opioid Analgesics and Persistent Pain After an Acute Pain Emergency Department Visit: Evidence from a Cohort of Suspected Urolithiasis Patients. J Emerg Med 2021; 61:637-648. [PMID: 34690022 DOI: 10.1016/j.jemermed.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/19/2021] [Accepted: 09/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Severe acute pain is still commonly treated with opioid analgesics in the United States, but this practice could prolong the duration of pain. OBJECTIVES Estimate the risk of experiencing persistent pain after opioid analgesic use after emergency department (ED) discharge among patients with suspected urolithiasis. METHODS We analyzed data collected for a longitudinal, multicenter clinical trial of ED patients with suspected urolithiasis. We constructed multilevel models to estimate the odds ratios (ORs) of reporting pain at 3, 7, 30, or 90 days after ED discharge, using multiple imputation to account for missing outcome data. We controlled for clinical, demographic, and institutional factors and used weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge. RESULTS Among 2413 adult ED patients with suspected urolithiasis, 62% reported persistent pain 3 days after discharge. Participants prescribed an opioid analgesic at discharge were OR 2.51 (95% confidence interval [CI] 1.82-3.46) more likely to report persistent pain than those without a prescription. Those who reported using opioid analgesics 3 days after discharge were OR 2.24 (95% CI 1.77-2.84) more likely to report pain at day 7 than those not using opioid analgesics at day 3, and those using opioid analgesics at day 30 had OR 3.25 (95% CI 1.96-5.40) greater odds of pain at day 90. CONCLUSIONS Opioid analgesic prescription doubled the odds of persistent pain among ED patients with suspected urolithiasis. Limiting opioid analgesic prescribing at ED discharge for these patients might prevent persistent pain in addition to limiting access to these medications.
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20
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Eraybar S, Yuksel M. The prospective evaluation of the effectiveness of scoring systems in the emergency department in cases with suspected ureteral stones: STONE? CHOKAI? Am J Emerg Med 2021; 49:94-99. [PMID: 34098332 DOI: 10.1016/j.ajem.2021.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/18/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION This study evaluates the effectiveness of CHOKAI and STONE scores in patients presenting to the emergency department with ureteral stones. METHODS Patients over the age of 18 who were admitted to the emergency department with flank pain, groin pain, scrotal pain, and hematuria and who were performed non-contrast abdominal computed tomography (CT) for diagnostic imaging were included. The numeric pain, CHOKAI, and STONE scores of the patients were calculated. The effectiveness of these scoring systems in the presence of stones was examined. RESULTS A total of 105 patients were included in the study. In the analysis performed to investigate whether there was a difference between the numeric pain, STONE, and CHOKAI scores in terms of the presence of stones on CT, it was seen that the CHOKAI score was significantly different from the others (p < 0.001). A significant positive correlation was found between the CHOKAI score and stone size (r = 0.343, p < 0.001).When the cut-off value of the CHOKAI score was >7, the sensitivity was found to be 60.49%, and specificity was 83.33%. The cut-off value for the STONE score was >8 with a sensitivity of 70.37% and specificity of 58.33%. The corresponding area under curve values for the CHOHAI and STONE scores was 0.788 (p < 0.0001) and 0.615 (p = 0.087). Male sex, the CHOKAI, and STONE scores were the independent risk factors for ureteral stone. A significant positive correlation was found between the CHOKAI score and stone size (r = 0.343, p < 0.001). CONCLUSION The CHOKAI score has a higher performance than the STONE score in detecting the presence of ureteral stones. NEW KNOWLEDGE ADDED BY THIS STUDY The CHOKAI score has a higher performance than the STONE score in detecting the presence of ureteral stones. Especially in countries such as Turkey, where there are no specific racial differences, the STONE score may be diagnostically insufficient. The CHOKAI score shows the presence of the patient's stone and positively correlates with the size of the stone and the stone location. IMPLICATION FOR CLINICAL PRACTICE OR POLICY In the functioning of the emergency department, it is important to make the differential diagnosis of patients quickly and provide effective treatment. The use of diagnostic scoring systems saves time for the emergency physician in the differential diagnosis phase and guides in terms of applying for possible additional imaging methods.
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Affiliation(s)
- Suna Eraybar
- University of Health Sciences Turkey, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Emergency Medicine, Bursa, Turkey.
| | - Melih Yuksel
- University of Health Sciences Turkey, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Emergency Medicine, Bursa, Turkey.
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21
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Bhanot R, Jones P, Somani B. Minimally Invasive Surgery for the Treatment of Ureteric Stones - State-of-the-Art Review. Res Rep Urol 2021; 13:227-236. [PMID: 33987110 PMCID: PMC8110280 DOI: 10.2147/rru.s311010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023] Open
Abstract
The landscape of managing ureteric stones has evolved over the last few decades and several treatment options exist depending on the stone size, location, and other patient and stone factors. While open surgery is now rarely performed, the use of medical expulsive therapy (MET) has been controversial and perhaps only recommended for large distal ureteric stones. The mainstay treatment balances between shockwave lithotripsy (SWL) and ureteroscopy (URS), with the latter usually recommended for larger stones. While the principles of ureteric stone management have remained largely unchanged, the modern era has generated new methods and means to deliver it. Advancements have occurred in all domains of endourology to try and refine treatment and balance it with cost, patient choice and quality of life. Dissemination of technologies and demonstration of their efficacy and safety will eventually result in new recommendations among international guidelines and evolution of new gold standards.
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Affiliation(s)
- Radhika Bhanot
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Patrick Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,EAU Young Academic Urology Urolithiasis and Endourology Working Party, Arnhem, the Netherlands
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.,EAU Young Academic Urology Urolithiasis and Endourology Working Party, Arnhem, the Netherlands.,Manipal Academy of Higher Education, Manipal, India
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22
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Subramonian K, Barba HS, Darrad M. Role of conservative management of stones. Turk J Urol 2020; 46:S64-S69. [PMID: 33320082 DOI: 10.5152/tud.2020.20465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 11/22/2022]
Abstract
Urinary tract stone disease is one of the most common pathologies of the modern era with a rising prevalence owing to incidentally detected renal stones from imaging for other reasons. Although there is consensus on active management of symptomatic and asymptomatic stones in high-risk patient groups, conservative management of stones is still controversial. We have reviewed the literature pertaining to conservative management of 3 groups of stones-asymptomatic calyceal stones, staghorn stones, and ureteric stones-and summarized the findings to provide guidance in the conservative management of stones. In the calyceal stone group, our review showed an average spontaneous stone passage rate of 18% (range, 8%-32%) and an average requirement for surgical intervention of 20% (range, 7%-40%), with 62% of patients remaining safely on surveillance over a mean time of 4 years. In the staghorn group, overall disease-specific mortality was noted to be 16% (range, 0%-30%) and chance of renal deterioration was 21% (range, 0%-34.5%), with a mean incidence of infection of 22%. In case of conservatively managed ureteric stones, the rate of spontaneous passage for stones smaller than 5 mm was 75%, compared with 62% for those larger than 5 mm. Based on the position in the ureter, spontaneous passage rates were 49%, 58%, and 68% for proximal, middle, and distal thirds, respectively. Conservative management may be recommended for asymptomatic patients and those who are deemed unfit for any procedures. However, careful patient selection and thorough counseling about the risks of conservative management could make it a suitable option for an appropriate subset of patients.
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Affiliation(s)
- Kesavapillai Subramonian
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust Ringgold Standard Institution, Birmingham, UK
| | - Hector Sandoval Barba
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran Ringgold Standard Institution Tlalpan, DF, Mexico
| | - Maitrey Darrad
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust Ringgold Standard Institution, Birmingham, UK
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23
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Abid AF, Hussein NS. Fragmentation and propulsive effect of shock wave lithotripsy in treatment of small renal calculi. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00063-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Small renal calculi are frequently observed in clinical practice, and chemo-lytic therapy has limited effects. The purpose of the study is to evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of small renal calculi.
Methods
We studied 60 patients with small renal stones from March 2017 to March 2019. After excluding eight patients with incomplete data, the remaining 52 patients were evaluated. Patients with symptomatic single or multiple stones of 6–8 mm in diameter or asymptomatic on ultrasound and kidney-ureter-bladder radiograph were eligible for inclusion. Small stones were treated by ESWL. The data were analyzed using the Statistical Packages for Social Sciences - version 25 (IBM Corporation).
Results
The mean age of the 52 patients was 34.5 ± 9.5 years. Forty-one (78.8%) patients were symptomatic, while 11 (21.2%) were asymptomatic. Forty-seven (90.4%) had single small renal stones, while four patients had two stones (7.7%) and only one patient had three stones (1.9%). Forty-five stones were successfully treated by ESWL, while 13 stones failed to respond.
Conclusion
ESWL is a useful tool for treating small renal calculi; it works either by fragmenting the stones or by acting as a pushing force. However, further large prospective studies are needed to corroborate the above conclusions.
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24
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Al-Terki A, El-Nahas AR, Abdelhamid U, Al-Ruwaished MA, Alanzi T, Al-Shaiji TF. Development and validation of a score for emergency intervention in patients with acute renal colic secondary to ureteric stones. Arab J Urol 2020; 18:236-240. [PMID: 33312734 PMCID: PMC7717624 DOI: 10.1080/2090598x.2020.1761143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objectives: To develop and validate a scoring system to assess the need for emergency intervention (EI) in patients with uncomplicated acute renal colic (ARC) due to ureteric stones. Patients and methods: From May 2017 to April 2019, 382 adult patients presented to emergency department with ARC due to ureteral stones diagnosed by non-contrast computed tomography. Patients with solitary kidney, complications secondary to obstruction (intractable vomiting, fever or sepsis), bilateral ureteric stones, Stage ≥3 chronic kidney disease or those who underwent treatment of urolithiasis within the past 6 months were excluded. EI was performed in cases with persistent or recurrent pain despite analgesics. Multivariate analysis was performed for the first 200 patients to detect risk factors for EI. The score was developed from significant factors. Sensitivity and specificity of the ARC score were calculated using receiver operator characteristic (ROC) curve analysis. The data of last 182 patients were used for validation of the score. Results: In the first 200 patients, EI was needed in 119 patients (59.5%) and included ureteric stents in 92, ureteroscopy in 25 and percutaneous nephrostomy in two. Significant factors for EI were stone location (relative risk [RR] 3.34, P = 0.026), creatinine level (RR 1.04, P < 0.001), leucocyte count (RR 1.69, P < 0.001), and stone length (RR 1.85, P < 0.001). A score using these four variables was developed. The ARC score sensitivity was 86%, specificity was 80% and the area under the ROC curve was 0.902. Validation of the score showed strong correlation between ARC score and need for EI (r = 0.788, P < 0.001). Conclusions: The ARC score is a validated, highly sensitive and specific novel score to determine the need for EI in patients with uncomplicated ARC secondary to ureteric stones. Abbreviations: ARC: acute renal colic; AUC: area under the ROC curve; CDR: clinical decision rules; CKD: chronic kidney disease; ED: emergency department; EI: emergency intervention; MET: medical expulsive therapy; NCCT: non-contrast CT; PCNL, percutaneous nephrolithotomy; ROC: receiver operator characteristic; S.T.O.N.E.: stone size (S), tract length (T), obstruction (O), number of involved calyces (N), and essence or stone density (E); SWL: extracorporeal shockwave lithotripsy; URS: ureteroscopy; WBC: white blood cell.
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Affiliation(s)
| | - Ahmed R El-Nahas
- Urology Unit, Al-Amiri Hospital, Kuwait City, Kuwait.,Professor of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.,Urology Consultant, Al-Amiri Hospital, Gulf Road, Sharq, Kuwait City, Kuwait
| | | | | | - Talal Alanzi
- Urology Unit, Farwaniya Hospital, Farwaniyah Governorate, Farwaniyah, Kuwait
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25
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Katayama S, Yoshioka T, Sako T, Murao W, Araki M, Watanabe T, Takenaka T. Association of Severe Microscopic Hematuria with Successful Conservative Treatment of Single Uncomplicated Ureteral Calculus: A Multicenter Cohort Study. Eur Urol Focus 2020; 7:812-817. [PMID: 32360254 DOI: 10.1016/j.euf.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/02/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although detection of microscopic hematuria is a well-known diagnostic method for urolithiasis, its ability to predict urolithiasis treatment outcomes in adults is unknown. OBJECTIVE To evaluate the role of microscopic hematuria in conservative treatment of ureteral calculus. DESIGN, SETTING, AND PARTICIPANTS This cohort study involved 482 patients who were diagnosed with a single uncomplicated ureteral calculus (≤10 mm) using computed tomography and underwent conservative therapy at two Japanese community hospitals between 2013 and 2018. Patients were divided into three groups according to the severity of microscopic hematuria (no, ≤4; mild to moderate, 5-99; and severe, ≥100 red blood cells per high-power field) and as determined during the first emergency department or urologic outpatient clinic visit. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A multivariate logistic regression analysis was performed to estimate the odds ratio for successful conservative therapy at 28 d after the diagnosis. Statistical significance was set at p < 0.05. RESULTS AND LIMITATIONS Of the 482 patients, 81 (16.8%), 209 (43.4%), and 192 (39.8%) had no, mild to moderate, and severe microscopic hematuria, respectively. After adjustments for six relevant confounders, severe microscopic hematuria showed a significant association with successful conservative therapy at 28 d (adjusted odds ratio, 1.91; 95% confidence interval, 1.02-3.57; p = 0.043), whereas mild to moderate microscopic hematuria did not (adjusted odds ratio, 1.05; 95% confidence interval, 0.57-1.93; p = 0.872) when compared with no microscopic hematuria. CONCLUSIONS Severe microscopic hematuria was significantly associated with successful conservative therapy for single uncomplicated ureteral calculus. PATIENT SUMMARY Microscopic hematuria might have predictive value for conservative treatment of a single uncomplicated ureteral calculus. Using the presence or absence of blood in urine and other predictive factors, clinicians may lead patients with a single uncomplicated ureteral calculus to successful conservative therapy.
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Affiliation(s)
- Satoshi Katayama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; Department of Urology, Japanese Red Cross Okayama Hospital, Okayama, Japan; Department of Urology, Himeji St. Mary's Hospital, Himeji, Japan; Okayama Urological Research Group (OURG), Okayama, Japan
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC(2)LE), Fukushima Medical University, Fukushima, Japan.
| | - Tomoko Sako
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; Department of Urology, Japanese Red Cross Okayama Hospital, Okayama, Japan; Okayama Urological Research Group (OURG), Okayama, Japan
| | - Wataru Murao
- Department of Urology, Himeji St. Mary's Hospital, Himeji, Japan; Okayama Urological Research Group (OURG), Okayama, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; Okayama Urological Research Group (OURG), Okayama, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; Okayama Urological Research Group (OURG), Okayama, Japan
| | - Tadasu Takenaka
- Department of Urology, Japanese Red Cross Okayama Hospital, Okayama, Japan; Okayama Urological Research Group (OURG), Okayama, Japan
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Cheng RZ, Shkolyar E, Chang TC, Spradling K, Ganesan C, Song S, Pao AC, Leppert JT, Elliott CS, To'o K, Conti SL. Ultra-Low-Dose CT: An Effective Follow-Up Imaging Modality for Ureterolithiasis. J Endourol 2020; 34:139-144. [DOI: 10.1089/end.2019.0574] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robin Z. Cheng
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Tim C. Chang
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Kyle Spradling
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Calyani Ganesan
- Department of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Shen Song
- Department of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Alan C. Pao
- Department of Nephrology, Stanford University School of Medicine, Stanford, California
| | - John T. Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | | | - Katherine To'o
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Simon L. Conti
- Department of Urology, Stanford University School of Medicine, Stanford, California
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Rice P, Prattley S, Somani BK. 'Negative Ureteroscopy' for Stone Disease: Evidence from a Systematic Review. Curr Urol Rep 2019; 20:13. [PMID: 30729326 DOI: 10.1007/s11934-019-0878-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW While ureteroscopy (URS) is a common procedure for ureteric stones, this window between diagnosis and treatment leaves the possibility for a 'negative', 'stoneless' or 'diagnostic' URS. We perform a systematic review to look at the rate of 'negative ureteroscopy' and risk factors associated with it. RECENT FINDINGS From a total of 3599 articles and 68 abstracts, 4 studies (1336 patients) were selected. The negative URS rate varied from 4 to 14%. Common predictors seem to be female gender, small stones, radiolucent stones and distal ureteric stones. Although infrequent, negative ureteroscopy should be avoided in patients with ureteric stones by performing a low-dose CT scan on the day of surgery. This should especially be performed for females and those with smaller, radiolucent or distal ureteric stones.
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Affiliation(s)
- Patrick Rice
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Sarah Prattley
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK. .,University of Southampton, Southampton, SO16 6YD, UK.
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Keller EX, De Coninck V, Audouin M, Doizi S, Daudon M, Traxer O. Stone composition independently predicts stone size in 18,029 spontaneously passed stones. World J Urol 2019; 37:2493-2499. [DOI: 10.1007/s00345-018-02627-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/31/2018] [Indexed: 01/30/2023] Open
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EL-Nahas AR. Editorial Comment on: Natural History of Conservatively Managed Ureteral Stones: Analysis of 6600 Patients by Yallappa et al.. J Endourol 2018; 32:380. [DOI: 10.1089/end.2018.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ahmed R. EL-Nahas
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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