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Orosco E, Terai H, Lotterman S, Baker R, Friedman C, Watt A, Beaubian D, Grady J, Delgado J, Herbst MK. Point-of-care ultrasound associated with shorter length of stay than computed tomography for renal colic. Am J Emerg Med 2024; 79:167-171. [PMID: 38452429 DOI: 10.1016/j.ajem.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Despite similar diagnostic effectiveness for renal colic, computed tomography (CT) is more resource intensive than point-of-care ultrasound (PoCUS). We sought to compare Emergency Department (ED) length of stay (LOS) among patients with renal colic according to imaging modality utilized. We secondarily compared rates of infection, return ED visits, missed significant pathology, and urologic intervention. METHODS This was a 12-month (1/1/22-12/31/22) multi-site retrospective cohort study of all patients diagnosed with renal colic who presented to the ED on days when at least one patient had a billable renal PoCUS examination performed. Patients with a history of genitourinary malignancy, pregnancy, renal transplant, hemodialysis, single kidney, prior visit for renal colic in the previous 30 days, or an incomplete workup were excluded. Median ED LOS was compared using a Wilcoxon rank sum test, and the 95% confidence limits for the difference between medians was calculated. Secondary outcomes were compared using a Fisher's Exact test. RESULTS Of 415 patients screened, 325 were included for analysis: 150 had CT alone, 80 had PoCUS alone, 54 had PoCUS plus CT, and 41 had neither. Median LOS for PoCUS alone was 75.0 (95% CI 39.3-110.7) minutes shorter than CT alone (231.5 vs. 307.0 min, p < 0.0001). Similar rates of infection, return visits, and missed pathology occurred across all groups (p > 0.10). Urologic interventions were higher in the PoCUS plus CT (25.9%) group compared to CT alone (7.3%), PoCUS alone (2.5%), and neither (7.3%), p < 0.0001. CONCLUSION Among patients with renal colic, PoCUS was associated with shorter ED LOS compared to CT, without differences in infection rates, return visits, or missed pathology. Patients with PoCUS plus CT had a higher rate of urologic interventions, suggesting PoCUS may have a role in identifying patients who would most benefit from CT.
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Affiliation(s)
- Emily Orosco
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Hiromi Terai
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Seth Lotterman
- Hartford Hospital, Department of Emergency Medicine, Hartford, CT, United States of America
| | - Riley Baker
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Cade Friedman
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Aren Watt
- University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Drew Beaubian
- University of Connecticut School of Medicine, Department of Emergency Medicine, Farmington, CT, United States of America
| | - James Grady
- University of Connecticut School of Medicine, Department of Public Health Sciences, Farmington, CT, United States of America
| | - João Delgado
- Hartford Hospital, Department of Emergency Medicine, Hartford, CT, United States of America
| | - Meghan Kelly Herbst
- University of Connecticut School of Medicine, Department of Emergency Medicine, Farmington, CT, United States of America.
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Hemo O, Dotan A, Shvero A, Kleinmann N, Dotan ZA, Zilberman DE. High ambient temperature impact on the pattern of emergency-room visits due to renal colic in the Middle East. Urolithiasis 2024; 52:54. [PMID: 38564058 DOI: 10.1007/s00240-024-01560-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
Urolithiasis has a seasonal pattern, with an established increase in incidence during the summer months. This study aims to assess the impact of high ambient temperatures on emergency room (ER) visits related to renal colic (RC) in a Middle Eastern country over the past decade. Population data were extracted using the MDClone Big Data platform. We recorded demographic and clinical data on all RC-associated ER visits from January 2012 to April 2023 and calculated the heat index (HI) that combines daily average coastal plane temperatures and humidity percentages. There was a total of 12,770 ER visits (median age 48 years, 9,236 (72%) males). The number of visits increased during the hottest months (July-October), with the highest numbers recorded during August. The number of visits remained stable throughout the study. We identified a linear association between humidity and the incidence of ER visits (p = 0.002), and a non-linear association between ambient temperature (p < 0.0001) and HI (p < 0.0001). There was a direct relationship between high temperatures and ER visits on the same day (risk ratio [RR]: 1.75, p = 0.036), with a 2-day lag (RR: 1.123, p = 0.024). In Conclusion, there is a significant relationship between temperature, humidity, HI, and the number of ER visits due to RC. Adjusted resource allocation and healthcare workforce availability are essential for managing additional cases during heat waves. Clinical implications: Increased demand is expected during heatwaves and within a 2-day lag, emphasizing the importance of proactive strategies to effectively manage RC patients.
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Affiliation(s)
- Orel Hemo
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel.
| | - Arad Dotan
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asaf Shvero
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel
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Anderson T, Hopper C, MacCraith E, McCabe A, Shortt CP. Assessment of clinically significant urolithiasis positivity rate using CT KUB for suspected renal colic. Ir J Med Sci 2024; 193:1009-1013. [PMID: 37542633 DOI: 10.1007/s11845-023-03477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Unenhanced low-dose computed tomography of the kidneys, ureter and bladder (CT KUB) is the gold standard diagnostic imaging modality in the assessment of suspected renal colic. As the radiation dose is not negligible, it is important to monitor the diagnostic yield of CT KUBs. The aim of this study is to evaluate the diagnostic yield of CT KUB studies performed for suspected renal colic in patients presenting to the emergency department. METHODS A retrospective review was performed of 500 patients who underwent CT KUB for suspected renal colic over a seven month period from June 2019 to January 2020. Clinical information and imaging was reviewed for each patient. Statistical analysis was performed using GraphPad Prism 8 (GraphPad Software, San Diego, CA, USA). RESULTS Forty-nine percent of patients in the series were female (248/500) and the mean age was 45. The positivity rate for obstructing ureteral calculus was 34% (169/500). Concerningly, there was a significantly lower positivity rate in females compared to males (19% versus 48%; p < 0.0001) which raises the issue of unnecessary radiation exposure to this cohort. In the 200 female patients who were negative for obstructing urolithiasis, the mean age was 43. Females also had a significantly higher rate of negative CT KUB (62% versus 37%; p < 0.0001) where no underlying alternative pathology was diagnosed. CONCLUSIONS Women are less likely than men to have obstructing urolithiasis on CT KUB for suspected renal colic. This difference is not accounted for by a higher rate of alternative diagnoses among female patients. The findings of this study should prompt clinicians to exercise caution when considering this imaging modality in this patient cohort.
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Wakai A, Atkinson P. Non-specialist emergency physician-performed point-of-care ultrasound (POCUS) for renal colic-No hocus POCUS! CAN J EMERG MED 2024; 26:139-140. [PMID: 38367158 DOI: 10.1007/s43678-024-00662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Affiliation(s)
- Abel Wakai
- Department of Emergency Medicine, Beaumont Hospital, Dublin, and Emergency Care Research Unit (ECRU), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada
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Lee WF, Goh SJ, Lee B, Juan SJ, Asinas-Tan M, Lim BL. Renal point-of-care ultrasound performed by ED staff with limited training and 30-day outcomes in patients with renal colic. CAN J EMERG MED 2024; 26:198-203. [PMID: 38219263 DOI: 10.1007/s43678-023-00645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND AND AIM Emergency Department (ED) renal point-of-care ultrasound (PoCUS) in renal colic by accredited specialists has good prognostic value. This may not be generalizable to under-resourced EDs. We investigated PoCUS in renal colic in our ED with lesser training. METHODS We performed a single-centre health records review of adult ED patients with renal colic and PoCUS. Patients were managed by a non-ED specialist/resident doctor with no POCUS accreditation in consultation with an attending. These doctors attended a 3.5-h training session conducted by accredited attendings to examine hydronephrosis. They needed to verify their PoCUS findings with an attending during the first two weeks of their six-month posting before performing it independently. The primary outcome was 30-day urological procedures in hydronephrotic vs. non-hydronephrotic groups. Secondary outcomes were the distribution of primary outcome with grades of hydronephrosis, 30-day ED nephrolithiasis-related reattendances in hydronephrotic vs. non-hydronephrotic groups and its distribution with grades of hydronephrosis. We compared outcomes using Fisher's exact test. We also reported crude odds ratio (COR) and 95% CI of primary outcome between hydronephrotic vs. non-hydronephrotic groups. p values ≤ 0.05 were significant. RESULTS We recruited 651 patients; 160 (24.6%) without and 491 (75.4%) with hydronephrosis. Rates of grades of hydronephrosis were: mild (76.6%), moderate (13.8%), severe (1.2%) and undifferentiated (8.4%). There was a difference in 30-day urological procedures (rates [95% CI]) in hydronephrotic vs. non-hydronephrotic groups, 11.2 [8.7-14.0]% vs. 2.5 [1.0-6.3]%; p < 0.001; COR (95% CI) 4.9 (1.8-13.8); p = 0.002. Increasing 30-day urological procedural rates were associated with increasing grade of hydronephrosis [no: 2.5%, mild: 7.7%, moderate: 23.5%, severe: 67.0% and undifferentiated: 14.6%; p < 0.001]. No differences occurred in other secondary outcomes. CONCLUSIONS Renal PoCUS could be performed by non-ED specialist/resident doctors to identify patients without hydronephrosis who rarely required urological intervention. Hydronephrotic patients could benefit from further risk stratification.
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Affiliation(s)
- W F Lee
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore.
| | - S J Goh
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore
| | - Berlin Lee
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore
| | - S J Juan
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore
| | - Marxengel Asinas-Tan
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore
| | - B L Lim
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Deng S, Guo D, Liu L, Wang Y, Fei K, Zhang H. Preference for diagnosing and treating renal colic during pregnancy: a survey among Chinese urologists. Sci Rep 2024; 14:2914. [PMID: 38316888 PMCID: PMC10844619 DOI: 10.1038/s41598-024-53608-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024] Open
Abstract
To explore the preference for diagnosing and treating renal colic during pregnancy among Chinese urologists. A questionnaire was designed using the Sojump® platform. WeChat, the largest social networking platform in China, was used to distribute the questionnaire to urologists at hospitals of all levels in China. In total, 110 responses were included. Of the respondents, 100.0% used ultrasound to diagnose renal colic during pregnancy, followed by magnetic resonance imaging (17.3%) and low-dose CT (3.6%). Phloroglucinol (80.9%) and progesterone (72.7%) were the most commonly used antispasmodics and analgesics. Opioid analgesics were not commonly used (12.7%). Most of the respondents (63.6%) indicated that no more than 20% of the patients needed surgical intervention. If surgery was unavoidable, 95.5% preferred temporary renal drainage, including ureteral stenting (92.7%) and percutaneous nephrostomy (2.7%). However, some respondents still preferred definitive stone treatment, such as ureteroscopy lithotripsy (3.6%) and percutaneous nephrolithotomy (0.9%). Moreover, there were no differences in the choices of urologists with different professional titles regarding diagnostic tools, most therapeutic medications, or surgical methods (p > 0.05). Ultrasound is the preferred tool for diagnosing renal colic during pregnancy. Low-dose CT is still not widely accepted. Pregnant patients with renal colic are initially treated conservatively. Urologists prefer ureteral stenting when there are clinical indications for intervention.
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Affiliation(s)
- Shidong Deng
- Department of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Dayong Guo
- Department of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Lingzhi Liu
- Department of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Yurou Wang
- Department of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Kuilin Fei
- Department of Obstetrics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Huihui Zhang
- Department of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
- Institute of Hospital Administration, University of South China, Hengyang, China.
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McMahon B, Prabhu A, Thode HC, Singer A. Transcutaneous electrical nerve stimulation (TENS) versus sham TENS in adult ED patients with abdominal pain: A clinical trial. Am J Emerg Med 2024; 76:7-12. [PMID: 37972505 DOI: 10.1016/j.ajem.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE There is a growing consensus that the risks of current pharmacologic analgesics warrant consideration of alternative modalities for acute and chronic pain control. The objective of this study was to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in adult emergency department (ED) patients presenting with abdominal pain. METHODS We conducted a patient and observer blinded randomized controlled trial comparing TENS to sham TENS. The study was conducted at a large suburban academic ED. Patients with abdominal pain and a verbal numeric pain scale (VNS) of 5 or greater were randomized to TENS or sham TENS applied via 4 skin pads, one in each abdominal quadrant for 30 min. The primary outcome was change in pain scores 30 min after the intervention. Our study had 80% power to detect a between group difference of 1.5 points on the VNS. RESULTS 81 patients were randomized to TENS (n = 41) or sham TENS (n = 40). Groups were similar in baseline characteristics. The mean (SD) reductions in pain scores were 1.9 (2.1) and 1.7 (2.6) in patients treated with TENS and sham TENS respectively (P = 0.81). Use of rescue medications in patients with treated with TENS and sham TENS was similar (49 vs 55% respectively, P = 0.66). CONCLUSIONS Application of TENS to the abdominal wall did not result in more effective pain relief than sham TENS in adult ED patients with abdominal pain.
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Affiliation(s)
- Brian McMahon
- Department of Emergency Medicine, SUNY, Stony Brook, NY, United States of America
| | - Aditi Prabhu
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Henry C Thode
- Department of Emergency Medicine, SUNY, Stony Brook, NY, United States of America
| | - Adam Singer
- Department of Emergency Medicine, SUNY, Stony Brook, NY, United States of America.
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Nogara A, Lucignani G, Turetti M, Silvani C, Marmiroli A, Nizzardo M, Gadda F, Zanetti SP, Longo F, De Lorenzis E, Albo G, Salonia A, Montanari E, Boeri L. Prevalence and predictors of stone passage after double J stenting for symptomatic ureteral stones: a cross-sectional, real-life study. World J Urol 2024; 42:8. [PMID: 38180579 DOI: 10.1007/s00345-023-04717-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/10/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE To evaluate the rate of and predictors of stone passage (SP) after urgent retrograde stenting for symptomatic ureteral stones. METHODS We retrospectively analysed data from 249 consecutive patients presenting to the emergency department for symptomatic ureteral stones and treated with retrograde stenting. Demographic, clinical and laboratory characteristics were collected. Stones parameters were collected before stenting and SP was evaluated at 1 month with computerized tomography. Descriptive statistics and logistic regression models tested the association between predictors and SP. RESULTS Overall, median (IQR) age and stone diameter were 56 (45-68) years and 7.1 (4.4-9.8) mm, respectively. Stones were located in the proximal, mid and distal ureter in 102 (41.0%), 48 (19.3%) and 99 (39.8%) cases. SP was observed in 65 (26.2%) individuals. Stone diameter (3.2 vs. 7.7 mm, p < 0.001) and stone density (416 vs. 741, p < 0.001) were lower and a higher rate of distal stones (76.9% vs. 26.7%, p < 0.001) was found in the SP group compared to that with persistent stones. Multivariable logistic regression analysis showed that distal ureteral stone location (OR 7.9, p < 0.01) and lower HU (OR 0.9, p < 0.01) were associated with SP, after accounting for stone volume. Patients with a distal stone of 500 HU had a 75% probability of SP. CONCLUSION Stone passage occurred in 26% of patients with indwelling stent due to symptomatic ureteral stones. Lower stone density and distal stone location were independent predictors of stone passage. Patients with these criteria should be managed with follow-up imaging and stent removal instead of ureteroscopy.
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Affiliation(s)
- Andrea Nogara
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
| | - Gianpaolo Lucignani
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
| | - Matteo Turetti
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
| | - Carlo Silvani
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
| | - Andrea Marmiroli
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
| | - Marco Nizzardo
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
| | - Franco Gadda
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
| | - Fabrizio Longo
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
| | - Elisa De Lorenzis
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
| | - Giancarlo Albo
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 15, 20122, Milan, MI, Italy.
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Secourgeon A, Bigot P, Martin L, Lebdai S. [Prospective controlled study evaluating teleconsultation and tele-semiology for the management of renal colic]. Prog Urol 2023; 33:1033-1040. [PMID: 37806910 DOI: 10.1016/j.purol.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Physical examination appears to be a limiting factor of teleconsultation (TC). We evaluated the feasibility of self-percussion of the lumbar fossae (sPLF) and TC for simple renal colic (SRC) in comparison with a face-to-face consultation (FC). MATERIAL AND METHODS We performed a comparative prospective study in two steps. First: evaluation of the quality of an sPLF on a standardized patient in TC, without and with tutorial. Secondarily: evaluation of a TC and a FC for a SRC with a standardized patient in real conditions. Evaluation using objective clinical scores and qualitative scales by an observer, the standardized patient and the practitioner himself. RESULTS Forty-two practitioners were included in the study. In the absence of a tutorial, the sPLF was most often "poorly done". The tutorial led to a significant improvement in the quality of sPLF. There was no difference in diagnostic and therapeutic performance among senior physicians between TC and FC. The therapeutic performances of the interns were significantly lower in TC without his being aware of it. The qualitative scores were significantly lower in TC vs FC according to the practitioners, the standardized patient and the observer. CONCLUSION An sPLF is feasible but its practice should be taught. Unlike interns, senior physicians were able to perform a TC comparable to FC for the management of SRC. TC and telesemiology therefore require dedicated training and an experienced practitioner. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- A Secourgeon
- Service d'urologie, CHU d'Angers, Angers, France.
| | - P Bigot
- Service d'urologie, CHU d'Angers, Angers, France
| | - L Martin
- Service de dermatologie, CHU d'Angers, Angers, France; Centre de simulation All'Sims, CHU et Université d'Angers, Angers, France
| | - S Lebdai
- Service d'urologie, CHU d'Angers, Angers, France; Centre de simulation All'Sims, CHU et Université d'Angers, Angers, France
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Meria P, Raynal G, Denis E, Plassais C, Cornet P, Gil-Jardiné C, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Management of symptomatic urinary stones. Prog Urol 2023; 33:791-811. [PMID: 37918980 DOI: 10.1016/j.purol.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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 acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context.
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Affiliation(s)
- P Meria
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France
| | - G Raynal
- Clinique Métivet, department of urology, Saint-Maur-des-Fossés, France
| | - E Denis
- Centre hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - C Plassais
- Department of Urology, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France
| | - P Cornet
- Department of General Medicine, Sorbonne University, SFMG, Paris, France
| | - C Gil-Jardiné
- Pôle Urgences adultes - SAMU, Hôpital Pellegrin, CHU de Bordeaux, SFR-SIGU, Bordeaux, France; Inserm U1219, Bordeaux Population Health Research Centre, IETO Team, Bordeaux University, ISPED, Bordeaux, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Golomb D, Shemesh A, Goldberg H, Hen E, Atmana F, Barkai E, Shalom B, Cooper A, Raz O. Effect of gender on presentation and outcome of renal colic. Urologia 2023; 90:653-658. [PMID: 36635856 DOI: 10.1177/03915603221150039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To examine gender-related differences in the presentation, management, and outcomes of patients admitted to the emergency department ED with ureteral stones. METHODS Retrospective analysis of all patients admitted to the ED at our institution, found to have a ureteral stone on CT. Clinical, laboratory, imaging parameters, and outcomes were collected. RESULTS 778 patients were admitted with ureteral stones between January 2018 and December 2020. 78% (n = 609) were males and 22% (n = 169) were females. The mean ages were 49.4 (SD 14.4) and 51.6 (SD 15.7) in males and females, respectively (p = 0.08). Female patients presented with a higher body temperature (p = 0.01), pulse rate (p < 0.0001), nausea and vomiting (p < 0.0001), elevated serum C-reactive protein (CRP) (p = 0.002) compared to males. The prevalence of elevated serum creatinine was higher in males (p < 0.0001). Alpha-blockers were recommended on discharge in 54.8% (334) of males, compared to only 29.6% (50) of females (p < 0.0001). Spontaneous stone expulsion was significantly higher in males compared to females (p = 0.01). CONCLUSIONS Our results demonstrate that gender does effect presentation and outcome of patients presenting with renal colic. Females were found to have elevated infectious parameters, more nausea and vomiting and a higher incidence of positive urine cultures. Males admitted to the ED were found to have significantly higher serum creatinine levels. Medical expulsive therapy (MET) with alpha-blockers was prescribed significantly less in female patients, which may have resulted in a lower spontaneous stone expulsion rate.
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Affiliation(s)
- Dor Golomb
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Amit Shemesh
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Hanan Goldberg
- Department of Urology, State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Eyal Hen
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Fahed Atmana
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Eyal Barkai
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Ben Shalom
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Amir Cooper
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Orit Raz
- Department of Urology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
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王 明, 姬 家, 赖 金, 唐 鑫, 胡 浩, 王 起, 许 克, 徐 涛, 胡 浩. [Choice of medical treatment for renal colic: A survey of Chinese urologists]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:871-875. [PMID: 37807742 PMCID: PMC10560911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To investigate the status quo of recognition and management of renal colic among urological surgeons in China. METHODS From November 2021 to March 2022, 725 urological surgeons in China were surveyed in the form of a questionnaire, including their province, hospital grade, professional title, the number of patients with renal colic treated per week, the preferred drugs and the cognition of the disease. This study was approved by the Medical Ethics Committee of Peking University People's Hospital, and all respondents completed informed consent online. RESULTS During November 2021 and March 2022, urological surgeons across China were surveyed in the form of a questionnaire, and the reliability and validity of the questionnaire were verified before the study was carried out. In the study, 720 valid questionnaires were collected (accounting for 99.31% of the total number), in which 42.4% of the doctors' preferred drugs were non-steroidal anti-inflammatory drugs (NSAIDs), and 40.0% of the doctors' preferred antispasmodic drugs. Opioids were the first choice of 11.0% of the physicians and other treatments were preferred by 6.6% of physicians. In addition, 61.1% of the doctors thought that the mechanism of renal colic was elevated prostaglandin, 32.2% thought it was ureteral spasm, 5.0% thought it was calculi irritation, and 1.7% thought the mechanism was unclear. The doctor of the cognition of the generation mechanism of renal colic pain had a significant influence on the preferred treatment option (χ2=54.399, P < 0.001) that the "elevated prostaglandins" doctor more often preferred NSAIDs than the doctor who thought cramps and ureter stones caused renal colic (51.6% vs. 28.0%, χ2=34.356, P < 0.001;51.6% vs. 19.4%, χ2=13.759, P < 0.001). In addition, hospital class, physician title, and the number of weekly consultations by physicians influenced the choice of medications for renal colic (P < 0.05), tertiary hospitals, middle and senior professional titles and weekly patients with renal colic > 8 cases generally preferred NSAIDs. CONCLUSION There are deficiencies in the cognition and drug treatment of renal colic among urological surgeons in China. The choice of the preferred drug was related to the doctor's cognition of the disease, the grade of the hospital, the doctor's professional title and the weekly treatment volume.
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Affiliation(s)
- 明瑞 王
- />北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People's Hospital, Beijng 100044, China
| | - 家祥 姬
- />北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People's Hospital, Beijng 100044, China
| | - 金惠 赖
- />北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People's Hospital, Beijng 100044, China
| | - 鑫伟 唐
- />北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People's Hospital, Beijng 100044, China
| | - 浩浦 胡
- />北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People's Hospital, Beijng 100044, China
| | - 起 王
- />北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People's Hospital, Beijng 100044, China
| | - 克新 许
- />北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People's Hospital, Beijng 100044, China
| | - 涛 徐
- />北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People's Hospital, Beijng 100044, China
| | - 浩 胡
- />北京大学人民医院泌尿外科, 北京 100044Department of Urology, Peking University People's Hospital, Beijng 100044, China
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Aykanat MC, Kılıç M, Cimilli Öztürk T, Ustaalioğlu İ, Ak R. The efficacy of intradermal sterile water application in severe renal colic: a randomised clinical trial. Urolithiasis 2023; 51:121. [PMID: 37823931 DOI: 10.1007/s00240-023-01496-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
It is important to do a fast and effective treatment for patients with renal colic pain in emergency departments for both patients' comfort and clinicians' patient management. In this study, we aimed primarily to test the efficacy of intradermal sterile water application as a rapid and effective treatment in severe renal colic. This is a single-centre, prospective, randomised controlled trial. Study group consists of patients with severe renal colic related to urolithiasis. Patients were randomly divided into three groups. The first group received only intramuscular diclofenac sodium, the second group received intramuscular diclofenac sodium and intradermal sterile water, and the third group received intramuscular diclofenac sodium together with intravenous fentanyl. Numerical Rating Scale was used to determine the level of pain before and after the treatment at the 1st, 5th, 15th, 30th, 60th and 120th minutes. 95 out of 201 patients with severe renal colic pain randomly divided into 3 groups. The pre-treatment pain severity of the groups was similar (p = 0.228). We found that the decrease in pain intensity was significantly faster in the intradermal sterile water group than the other groups even in the first minute. Percentages of patients who had 50% pain reduction, which is considered as successful treatment, was higher in the intradermal sterile water group (which had 75.9% success rate) in the first 5 min compared to the IM diclofenac sodium group (which had 7.1% success rate) and IV fentanyl group (which had 25% success rate) (p < 0.001). According to the results, pain control was achieved much faster than the other methods with intradermal sterile water injection. All methods were found to be effective in relieving the pain of the patients.
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Affiliation(s)
- Mustafa Caner Aykanat
- Department of Emergency Medicine, Başakşehir Çam Ve Sakura City Hospital, Istanbul, Turkey
| | - Mazlum Kılıç
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Tuba Cimilli Öztürk
- Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - İzzet Ustaalioğlu
- Department of Emergency Medicine, Kartal Dr. Lütfi Kırdar City Hospital, D-100 Güney Yanyol No:47 Cevizli Mevkii, 34865, Kartal, Istanbul, Turkey
| | - Rohat Ak
- Department of Emergency Medicine, Kartal Dr. Lütfi Kırdar City Hospital, D-100 Güney Yanyol No:47 Cevizli Mevkii, 34865, Kartal, Istanbul, Turkey.
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Zhang D, Liang P, Xia B, Zhang X, Hu X. Efficacy and Safety of Ketamine Versus Opiates in the Treatment of Patients with Renal Colic: A Systematic Review and Meta-analysis. Pain Ther 2023; 12:1079-1093. [PMID: 37284927 PMCID: PMC10289999 DOI: 10.1007/s40122-023-00530-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Renal colic is one of the most common urological emergencies, and is usually caused by ureteral colic spasms. Pain management in renal colic remains the central focus of emergency treatment. The purpose of this meta-analysis is to identify the efficacy and safety of ketamine versus opioids in the treatment of patients with renal colic. METHODS We searched PubMed, EMBASE, Cochrane Library, and Web of Science databases for published randomized controlled trials (RCTs) that referred to the use of ketamine and opioids for patients with renal colic. The methodology was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The mean difference (MD) or odds ratio (OR) with a 95% confidence interval (CI) was used to analyze the data. The results were pooled using a fixed-effects model or random-effects model. The primary outcome measure was patient-reported pain scores 5, 15, 30, and 60 min after drug administration. The secondary outcome measure was side effects. RESULTS The data analysis revealed that ketamine was similar to opioids in pain intensity at the time of 5 min post-dose (MD = - 0.40, 95% CI - 1.82 to 1.01, P = 0.57), 15 min post-dose (MD = - 0.15, 95% CI - 0.82 to 0.52, P = 0.67), 30 min post-dose (MD = 0.38, 95% CI - 0.25 to 1.01, P = 0.24). Also, the pain score of ketamine was better than that of opioids at 60 min after administration (MD = - 0.12, 95% CI - 0.22 to - 0.02, P = 0.02). As for safety, the ketamine group was linked to a significant decrease in the incidence of hypotensive (OR = 0.08, 95% CI 0.01-0.65, P = 0.02). The two groups did not statistically differ in the incidence of nausea, vomiting, and dizziness. CONCLUSIONS Compared with opioids, ketamine showed a longer duration of analgesia in renal colic, with satisfactory safety. TRIAL REGISTRATION The PROSPERO registration number is CRD42022355246.
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Affiliation(s)
- Dongxu Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, China
- Institute of Urology, Capital Medical University, Beijing, China
| | - Pu Liang
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Infectious Diseases, Beijing, China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People's Republic of China
| | - Bowen Xia
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, China
- Institute of Urology, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, China
- Institute of Urology, Capital Medical University, Beijing, China
| | - Xiaopeng Hu
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, China.
- Institute of Urology, Capital Medical University, Beijing, China.
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Wu LM, Liu Q, Yin XH, Yang LP, Yuan J, Zhang XQ, Wang YL. Wrist-ankle acupuncture combined with pain nursing for the treatment of urinary calculi with acute pain. World J Clin Cases 2023; 11:4287-4294. [PMID: 37449241 PMCID: PMC10337009 DOI: 10.12998/wjcc.v11.i18.4287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Urological calculi often cause renal colic, which is characterized by paroxysmal or persistent severe pain in the upper abdomen or lumbar region. Development of methods to quickly relieve these pain symptoms has garnered clinical attention. Wrist-ankle acupuncture is a type of floating acupuncture therapy administered at selected points in the carpal and ankle areas, and it has good pain-relieving effects. We used wrist-ankle acupuncture combined with pain nursing for pain intervention in patients with renal calculi to confirm its application and safety.
AIM To study the effect of wrist-ankle acupuncture combined with pain nursing in the treatment of urinary calculi with acute pain.
METHODS Eighty-two patients with urinary calculi with acute pain as the first symptom followed at our hospital from November 2019 to June 2021 were enrolled in the study and classified into two groups according to the odd and even numbers of the visit sequences, each with 41 cases. The control group received a routine nursing intervention and intramuscular injection of nonsteroidal anti-inflammatory drugs, whereas the observation group received pain management nursing and wrist-ankle acupuncture. Subsequently, the pain-relieving effect was compared between the two groups.
RESULTS The score on the visual analog scale (VAS) at 24, 48, and 72 h postintervention was decreased in both groups compared with the baseline data; moreover, the observation group scored significantly lower than the control group on the VAS at each time point after the intervention (P < 0.05). The clinical efficacy at 24 h postintervention was not significantly different between the two groups (P > 0.05). In turn, the pain recurrence rate at 72 h postintervention was lower in the observation group compared with the control group (P < 0.05). Finally, the nursing satisfaction rate in the observation group was significantly higher than that observed in the control group (P < 0.05). No serious adverse reactions occurred during the treatment and the safety of treatment was high in both groups.
CONCLUSION Wrist-ankle acupuncture combined with pain nursing for treating urolithiasis with acute pain effectively alleviated the degree of pain and reduced the recurrence rate, which was worthy of clinical application.
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Affiliation(s)
- Li-Mei Wu
- Nursing Clinic, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang 050000, Hebei Province, China
- Nursing Clinic, Hebei Technology Innovation Center of TCM Spleen and Kidney Diseases, Shijiazhuang 050000, Hebei Province, China
| | - Qian Liu
- Nursing Clinic, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang 050000, Hebei Province, China
- Nursing Clinic, Hebei Technology Innovation Center of TCM Spleen and Kidney Diseases, Shijiazhuang 050000, Hebei Province, China
| | - Xiao-Hua Yin
- Department of Nursing, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang 050000, Hebei Province, China
| | - Li-Ping Yang
- Department of Acupuncture and Moxibustion Orthopaedics, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang 050000, Hebei Province, China
| | - Jun Yuan
- Department of Acupuncture and Moxibustion, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang 050000, Hebei Province, China
| | - Xiao-Qi Zhang
- Experimental Acupuncture and Moxibustion Teaching and Research Office, Acupuncture and Moxibustion Tuina College of Hebei University of Traditional Chinese Medicine, Shijiazhuang 050200, Hebei Province, China
| | - Yan-Li Wang
- Department of Respiratory, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang 050000, Hebei Province, China
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Liem SS, Demus T, Perez A, Jivanji D, Lee CY, George KA, Perez A, Cubeddu L, Pereira JF. Recent trends in the prescription of opioids in the emergency department in patients with urolithiasis. Int Urol Nephrol 2023. [PMID: 36913168 DOI: 10.1007/s11255-023-03545-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Pain management is central in the treatment of urolithiasis. We aimed to estimate the impact of the 2017 Department of Health and Human Services declaration of an opioid crisis on prescribing patterns of opioids and NSAIDs in emergency department visits for urolithiasis. METHODS The National Health Ambulatory Medical Care Survey (NHAMCS) was queried for emergency department visits of adults with a diagnosis of urolithiasis. The association between urolithiasis and narcotic and NSAIDs prescription patterns was evaluated and compared at pre-declaration (2014-2016) to post-declaration (2017-2018) periods. RESULTS Opioids were prescribed in about 211 million (41.1%) out of 513 million emergency department visits, over a 5-year period. Diagnosis of urolithiasis accounted for 1.9% of the visits (6.0 million). The use of opioids was higher in urolithiasis (82.7%) compared to non-urolithiasis diagnosis (40.3%), as well as the use of multiple opioids per visit (p < 0.01 for all). There was an overall decrease in opioid prescriptions in the post-declaration period, - 4.3% for urolithiasis (p = 0.254) and - 5.6% for non-urolithiasis visits (p < 0.05). A decrease in the use of hydromorphone (- 47.5%. p < 0.001), an increase in the use of morphine (+ 59.7% p = 0.006), and an increase of 'other' opioids (+ 98.8%, p < 0.041), were observed. Opioids combined with NSAIDs comprised 72.6% of the opioid prescriptions and 62.3% of all analgesic prescriptions in visits with urolithiasis diagnosis. CONCLUSIONS The use of opioids when managing urolithiasis decreased 4.3% after the crisis declaration; however, statistically are not different from pre-declaration numbers. Most often, opioids were prescribed with NSAIDs in urolithiasis patients.
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Chan K, Shakir T, El-Taji O, Patel A, Bycroft J, Lim CP, Vasdev N. Management of urolithiasis in pregnancy. Curr Urol 2023; 17:1-6. [PMID: 37692143 PMCID: PMC10487296 DOI: 10.1097/cu9.0000000000000181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023] Open
Abstract
Urolithiasis is the most common cause of nonobstetric abdominal pain, resulting in 1.7 admissions per 1000 deliveries. Urolithiasis most commonly occurs in the second and third trimesters, with an incidence between 1:125 and 1:2000. Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in pathological outcomes. The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging. In addition, a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery. Affected pregnancies are conservatively managed; however, 1 in 4 requires surgical intervention. Indications for surgical interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy. Therefore, a multidisciplinary approach is required to optimize patient care. The diagnosis and management of urolithiasis in pregnancy are complex. We reviewed the role, safety, advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.
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Affiliation(s)
- Kimberley Chan
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Taner Shakir
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Omar El-Taji
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Amit Patel
- Radiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - John Bycroft
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Chou Phay Lim
- Gynaecology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Nikhil Vasdev
- Urology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Jia K, Yue R, Wu X, Pan L. Atrial myxoma presenting with sudden renal colic: A rare case report. Asian J Surg 2023; 46:1168-9. [PMID: 36028401 DOI: 10.1016/j.asjsur.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/06/2022] [Indexed: 02/08/2023] Open
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Arslan E, Mohamed AH. Evaluation, management, and analysis of demographic and radiological characteristics of patients with renal colic at a tertiary hospital in Somalia. Afr J Emerg Med 2022; 12:358-361. [PMID: 36032787 PMCID: PMC9396295 DOI: 10.1016/j.afjem.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 06/22/2022] [Accepted: 07/24/2022] [Indexed: 11/03/2022] Open
Abstract
Renal Colic is a common emergenbcy care complaint worldwide–but its epidemiology and strategies for evaluation and treatment have been little reported in Africa. To date, there have been no studies regarding epidemiologic and radiological findings of renal colic in the emergency centre reported from Somalia. Ultrasound can be the initial investigation of choice because it is safe, cheap, and may help guide for diagnosis and need for further imaging.
Background Renal colic is a common emergency centre (EC) complaint worldwide, but its epidemiology and strategies for evaluation and treatment have been little reported in Africa. To the best of our knowledge, this is the first study aimed at evaluating the radiological investigations, management, and analysis of demographic characteristics of patients with urinary system stones who visited the EC. Method A 3-year retrospective study of a total of 435 patients with acute renal colic who underwent radiologic investigations was included in this study. The overall positive stone rate, stone location, size, and hydronephrosis grade were assessed. The sensitivity and specificity of ultrasound were evaluated using patients with both an ultrasound and a non-contrast CT (NCCT). Results The mean age of the patients was 34.7years; males accounted for 71.3% (n = 310), while females were 28.7% (n = 125). Urolithiasis was found in 63.4% of the cases, 71.3% of males and 28.7% of the females had a stone diagnosis (P < 0001). There was no statistically significant association between age and stone diagnosis (P > 0.05). The sensitivity and specificity of USG were 86.1% and 94%, respectively. Seventy-two percent of the cases had ureteral stones (29% in proximal, 25% in UVJ, 9% in mid, and 9% in distal ureter), followed by 28% having renal stones (19% calyces and 9% in renal pelvis). The mean size of the stone was 5.9±1.8, half of the cases harbour stone size <5mm, followed by 30% in 5mm-1cm. Conclusion Due to the scarcity of well-equipped tertiary care hospitals and the low socioeconomic status of the patients living in Sub-Saharan Africa, Ultrasound can be the initial investigation of choice because it is safe, cheap, and may help guide diagnosis and the need for further imaging. However, NCCT remains the gold standard diagnosis of choice for acute flank pain.
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Affiliation(s)
- Ebubekir Arslan
- Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Abdikarim H Mohamed
- Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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21
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Gulen M, Satar S, Acehan S, Yildiz D, Aslanturkiyeli EF, Aka Satar D, Kucukceylan M. Perfusion index versus visual analogue scale: as an objective tool of renal colic pain in emergency department. Heliyon 2022; 8:e10606. [PMID: 36148281 PMCID: PMC9485029 DOI: 10.1016/j.heliyon.2022.e10606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/09/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Perfusion index (PI) has use to monitor sympathetic response changes to pain. In this study, we aimed to evaluate the utility of using perfusion index as an objective marker of pain relief and of the need for rescue analgesia in ED patients with documented renal colic. Methods We conducted a prospective observational study between January 2020 and December 2020. The demographic characteristics of the patients, their complaints, nephrolithiasis histories, vital signs, PI, and VAS scores (on admission and after treatment) were recorded. Results A total of 144 patients were included. All patients were administered 20 mg of Tenoxicam on admission. There was a statistically significant difference between the PI (<0.001) and VAS scores (<0.001) on admission and after the administration of Tenoxicam. 43.1% (n = 62) of the patients needed rescue analgesia. Accordingly to ROC curve, the ability of both PI2 (AUC: 0.615, 95%CI 0.519-0.711, p = 0.018) and ΔPI (AUC: 0.601, 95%CI 0.508-0.694, p = 0.039) indices were determined as statistically significant. The cutoff value of the PI2 level for the prediction of the needed rescue analgesia was 4.65 and the cutoff value for ΔPI (PI2-PI1) was 2. All patients had a pain VAS score of <3 and a mean PI of 5.7 ± 2.9 at discharge from the emergency department. Conclusion In patients presenting to the emergency department with renal colic, the PI value on admission and after analgesic therapy can be helpful in assessing the severity of pain and predict the need for rescue analgesia.
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Affiliation(s)
- Muge Gulen
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
- Corresponding author.
| | - Salim Satar
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Selen Acehan
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Derviş Yildiz
- Iskenderun State Hospital, Department of Emergency Medicine, Hatay, Turkey
| | | | - Deniz Aka Satar
- Adana City Training and Research Hospital, Department of Histology and Embryology and Andrology Laboratory, Adana, Turkey
| | - Melike Kucukceylan
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
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22
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Wang RC, Fahimi J, Dillon D, Shyy W, Mongan J, McCulloch C, Smith-Bindman R. Effect of an ultrasound-first clinical decision tool in emergency department patients with suspected nephrolithiasis: A randomized trial. Am J Emerg Med 2022; 60:164-170. [PMID: 35986979 DOI: 10.1016/j.ajem.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Previously, we found that the use of ultrasonography for patients with suspected nephrolithiasis resulted in similar outcomes and less radiation exposure vs. CT scan. In this study, we evaluated the implementation of an ultrasound-first clinical decision support (CDS) tool in patients with suspected nephrolithiasis. METHODS This randomized trial was conducted at an academic emergency department (ED). We implemented the ultrasound-first CDS tool, deployed when an ED provider placed a CT order for suspected nephrolithiasis. Providers were randomized to receiving the CDS tool vs. usual care. The primary outcome was receipt of CT during the index ED visit. Secondary outcomes included radiation dose and ED revisit. RESULTS 64 ED Providers and 254 patients with suspected nephrolithiasis were enrolled from January 2019 through Dec 2020. The US-First CDS tool was deployed for 128 patients and was not deployed for 126 patients. 86.7% of patients in the CDS arm received a CT vs. 94.4% in the usual care arm, resulting in an absolute risk difference of -7.7% (-14.8 to -0.6%). Mean radiation dose in the CDS arm was 6.8 mSv (95% CI 5.7-7.9 mSv) vs. 6.1 mSv (95% CI 5.1-7.1 mSv) in the usual care arm. The CDS arm did not result in increased ED revisits, CT scans, or hospitalizations at 7 or 30 days. CONCLUSIONS AND RELEVANCE Implementation of the US-first CDS tool resulted in lower CT use for ED patients with suspected nephrolithiasis. The use of this decision support may improve the evaluation of a common problem in the ED. TRIAL REGISTRATION ClinicalTrials.gov#NCT03461536.
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Affiliation(s)
- Ralph C Wang
- Department of Emergency Medicine, University of California, San Francisco, United States of America.
| | - Jahan Fahimi
- Department of Emergency Medicine, University of California, San Francisco, United States of America; Philip R Lee Institute for Health Policy Studies, University of California, San Francisco
| | - David Dillon
- Department of Emergency Medicine, University of California, San Francisco, United States of America
| | - William Shyy
- Department of Emergency Medicine, University of California, San Francisco, United States of America
| | - John Mongan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States of America
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States of America
| | - Rebecca Smith-Bindman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, United States of America; Philip R Lee Institute for Health Policy Studies, University of California, San Francisco
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23
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Strohmaier WL, Bonkovic-Őszi J. Are there seasonal variations in renal colic in uric acid stone formers in Germany? World J Urol 2022; 40:2099-2103. [PMID: 35690647 DOI: 10.1007/s00345-022-04058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/16/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Seasonal variations in renal colic have been described by many authors for different countries worldwide. In most studies, there was no differentiation with regard to stone composition. Recently, we demonstrated that there was no seasonal variation in renal colic and urine chemistry for calcium oxalate stone formers in Germany. As we have many uric acid stone formers (UASFs) in our region, we were interested in learning the situation of this type of stone. METHODS We studied 286 consecutive UASFs with symptoms of renal colic. We divided them into four groups according to the quarters of the year. For stone analysis, X-ray diffraction/polarizing microscopy was used. Additionally, the following general parameters were examined in all patients: age, BMI, blood pressure, stone frequency, diabetes mellitus; blood: creatinine, glucose, uric acid, calcium, sodium and potassium; urine: pH, volume, calcium, uric acid, citrate, ammonia, and urea. Using the statistical program Prism 5 (GraphPad Software, San Diego, USA), significant differences between the four groups were calculated by the Kruskal-Wallis test. RESULTS We observed significantly more UASFs with renal colic in the third and fourth quarters of the year. This is in contrast to our findings in calcium oxalate patients. However, there was no variation in metabolic parameters. CONCLUSION The reasons are unclear; different temperatures are not a sufficient explanation, as one quarter is in the warm season and the other one is in the cold season. Unfortunately, no data have been reported in the literature thus far. Further studies are required to better understand these findings.
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Affiliation(s)
- Walter Ludwig Strohmaier
- Department of Urology and Paediatric Urology, Regiomed-Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Germany. .,Medical School Regiomed and Academic Hospital of the University of Split, Split, Croatia.
| | - Judit Bonkovic-Őszi
- Department of Urology and Paediatric Urology, Regiomed-Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Germany.,Medical School Regiomed and Academic Hospital of the University of Split, Split, Croatia
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24
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Kurkar A, Elderwy AA, Osman MM, Abdelkawi IF, Shalaby MM, Abdelhafez MF. Predictors of successful emergency shock wave lithotripsy for acute renal colic. Urolithiasis 2022; 50:481-485. [PMID: 35657411 PMCID: PMC9300550 DOI: 10.1007/s00240-022-01332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/09/2022] [Indexed: 12/04/2022]
Abstract
The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6–12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.
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Affiliation(s)
- Adel Kurkar
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Ahmad A Elderwy
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Mahmoud M Osman
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Islam F Abdelkawi
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Mahmoud M Shalaby
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Mohamed F Abdelhafez
- Department of Urology, Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
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Redfern V, Mortimore G. Renal and ureteric stones: a clinical review. Br J Nurs 2022; 31:S14-S22. [PMID: 35559704 DOI: 10.12968/bjon.2022.31.9.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This clinical review on renal and ureteric stones discusses how stones form, the incidence, risks, and complications associated with calculi. It reflects on the management and treatment options available, and highlights the important contribution by nurses and those working in advanced clinical practice roles in using their knowledge and rational clinical decision making to ensure timely recognition, prompt investigation, management and ongoing health promotion.
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Affiliation(s)
- Vicky Redfern
- Advanced Clinical Practitioner, University Hospitals of Derby and Burton NHS Foundation Trust
| | - Gerri Mortimore
- Senior Lecturer, Department of Health, Psychology and Social Care, University of Derby
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26
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Johnson G, Tabner A, Fakis A, Sherman R, Chester V, Bedford E, Jackson R, Ratan H, Mason S. Salbutamol for analgesia in renal colic: study protocol for a prospective, randomised, placebo-controlled phase II trial (SARC). Trials 2022; 23:352. [PMID: 35468847 PMCID: PMC9036510 DOI: 10.1186/s13063-022-06225-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Renal colic is the pain experienced by a patient when a renal calculus (kidney stone) causes partial or complete obstruction of part of the renal outflow tract. The standard analgesic regimes for renal colic are often ineffective; in some studies, less than half of patients achieve complete pain relief, and a large proportion of patients require rescue analgesia within 4 h. Current analgesic regimes are also associated with significant side effects including nausea, vomiting, drowsiness and respiratory depression. It has been hypothesised that beta adrenoreceptor agonists, such as salbutamol, may reduce the pain of renal colic. They have been shown to impact a number of factors that target the physiological causes of pain in renal colic (ureteric spasm and increased peristalsis, increased pressure at the renal pelvis and prostaglandin release with inflammation). There is biological plausibility and a body of evidence sufficient to suggest that this novel treatment for the pain of renal colic should be taken to a phase II clinical trial. The aim of this trial is to test whether salbutamol is an efficacious analgesic adjunct when added to the standard analgesic regime for patients presenting to the ED with subsequently confirmed renal colic. METHODS A phase II, randomised, placebo-controlled trial will be performed in an acute NHS Trust in the East Midlands. Patients presenting to the emergency department with pain requiring IV analgesia and working diagnosis of renal colic will be randomised to receive standard analgesia ± a single intravenous injection of Salbutamol. Secondary study objectives will explore the feasibility of conducting a larger, phase III trial. DISCUSSION The trial will provide important information about the efficacy of salbutamol as an analgesic adjunct in renal colic. It will also guide the development of a definitive phase III trial to test the cost and clinical effectiveness of salbutamol as an analgesic adjunct in renal colic. Salbutamol benefits from widespread use across the health service for multiple indications, extensive staff familiarity and a good side effect profile; therefore, its potential use for pain relief may have significant benefits for patient care. TRIAL REGISTRATION ISRCTN Registry ISRCTN14552440 . Registered on 22 July 2019.
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Affiliation(s)
- Graham Johnson
- Emergency Department, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK. .,University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Andrew Tabner
- Emergency Department, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK
| | - Apostolos Fakis
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK
| | - Rachelle Sherman
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK
| | - Victoria Chester
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK
| | | | - Richard Jackson
- Liverpool CR-UK Centre Cancer Research UK, Liverpool Cancer Trials Unit 1st Floor, C Block, Waterhouse Building, 3 Brownlow Street, Liverpool, L69 3GL, UK
| | - Hari Ratan
- Nottingham University Hospitals, Hucknall Rd., Nottingham, NG5 1PB, UK
| | - Suzanne Mason
- CURE group, School of Health and Related Research, University of Sheffield, Sheffield, UK
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27
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Blas L, Bonanno N, Mieggi M, Ringa M, Contreras P, Ameri CA. [Risk factors for contrast extravasation in renal colic]. ARCH ESP UROL 2022; 75:256-261. [PMID: 35435162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Non-traumatic ruptureof the pyeloureterocaliceal system (PUC) is anuncommon clinical entity. The most frequent cause isureteral obstruction due to lithiasic pathology, whichis present in up to 75%. To our knowledge, there isno description in the literature of the possible factorsassociated with this event. Our objective is to analyzethe variables associated with intravenous contrastextravasation in patients with renal colic due to singleureteral lithiasis. MATERIALS AND METHODS: We performed aretrospective, descriptive analysis of a series ofpatients who, in the context of renal colic, presentedendovenous contrast extravasation throughthe urinary system in computed tomography (CT).Patients with single ureteral lithiasis without otherassociated pathology were included. A comparisonof the samples from the group with contrast leakage(group 1) with an equal number of consecutiveCT scans without contrast leakage (group 2) in patientswith renal colic lithiasis was performed in alogistic regression model to identify risk factors forcontrast leakage. RESULTS There were 117 cases of contrast leakagefrom January 2013 to July 2018. Eighty-sixpercent of the lithiases were 5 mm and 79% werelocated in the lower ureter. 72% of patients presentedwith intrarenal pelvis. In the univariate analysisboth location in lower ureter, lithiasis 5 mm, andintrarenal pyelic anatomy increased the probabilityof extravasation. In multivariate model, 5 mmlithiasis increased five times the risk of extravasationcompared to larger ones, the location in distalureter increased three times and the anatomy withintrarenal pelvis increased two times compared toother location and extrarenal pelvis, respectively, ina statistically significant way the risk of presentingcontrast leakage. CONCLUSION In this series, we found an increasedrisk of contrast leakage in a lithiasic renalcolic in patients with intrarenal pelvic anatomy,with lithiasis less than or equal to 5 mm and locatedin the lower ureter.
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Affiliation(s)
- Leandro Blas
- Hospital Alemán de Buenos Aires. Ciudad de Buenos Aires. Argentina
| | - Nicolas Bonanno
- Hospital Alemán de Buenos Aires. Ciudad de Buenos Aires. Argentina
| | - Mauro Mieggi
- Hospital Alemán de Buenos Aires. Ciudad de Buenos Aires. Argentina
| | | | - Pablo Contreras
- Hospital Alemán de Buenos Aires. Ciudad de Buenos Aires. Argentina
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Gulacti U, Algin A, Turgut K, Yavuz E, Aydin I, Buyukaslan H, Lok U, Arslan E, Gonel A. Transcutaneous electrical nerve stimulation (TENS) for the treatment of renal colic in the emergency department: A randomized, double-blind, placebo-controlled trial. Am J Emerg Med 2022; 56:127-132. [PMID: 35397352 DOI: 10.1016/j.ajem.2022.02.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
STUDY OBJECTIVE To determine the analgesic efficacy of TENS treatment in patients with renal colic in the emergency department (ED). METHODS This double-blind, randomized controlled trial was conducted in a tertiary care ED. Patients with a definitive diagnosis of renal colic were assigned (1:1) as randomized to receive the real TENS with frequency 100 Hz, pulse width 200 microseconds, voltage 2 mA, or placebo with sham TENS. Pain intensity was measured using visual analog scales (VAS) at baseline, after 15 and 30th minutes. RESULTS A total of 100 patients were included in the final analysis: 50 patients treated with real TENS and 50 patients treated with sham TENS. VAS scores in both groups were similar at baseline. The mean reduction in VAS score at 15 min was 33.3 ± 17.6 (95% Confidence interval (CI): 28.3 to 38.3) for the real TENS group and 14.9 ± 11.6 (95% CI 11.6 to 18.2) for the sham TENS group (mean difference: 18.4 (95% CI: 12.5 to 24.4, P < 0.0001). The mean reduction in VAS score at 30 min was 63.7 ± 21.1 (95% CI: 57.7 to 69.7) for the real TENS group and 14.9 ± 16.2 (95% CI: 19.5 to 10.3) for the sham TENS group (mean difference: 48.8, 95% CI: 41.4 to 56.3, P < 0.0001). Four patients (8%) in the real TENS group and 24 patients (48%) in the sham TENS group required the rescue medication after 30th minutes. CONCLUSIONS TENS is effective for acute pain treatment in renal colic patients in the ED. TENS therapy could be a treatment option for renal colic.
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Affiliation(s)
- Umut Gulacti
- Department of Emergency Medicine, Adiyaman University Medical Faculty, Adiyaman, Turkey.
| | - Abdullah Algin
- Department of Emergency Medicine, SBU Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Kasim Turgut
- Department of Emergency Medicine, Adiyaman University Medical Faculty, Adiyaman, Turkey
| | - Erdal Yavuz
- Department of Emergency Medicine, Adiyaman University Medical Faculty, Adiyaman, Turkey
| | - Irfan Aydin
- Department of Emergency Medicine, Adiyaman University Medical Faculty, Adiyaman, Turkey
| | - Hasan Buyukaslan
- Department of Emergency Medicine, Harran University Medical Faculty, Sanliurfa, Turkey
| | - Ugur Lok
- Department of Emergency Medicine, Sutcu imam University Medical Faculty, K.Maras, Turkey
| | - Ebru Arslan
- Department of Emergency Medicine, Adiyaman University Medical Faculty, Adiyaman, Turkey
| | - Ataman Gonel
- Department of Biochemistry, Medical Park Hospital, Gaziantep, Turkey
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29
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He M, Lin X, Lei M, Xu X, He Z. The identification of pregnant women with renal colic who may need surgical intervention. BMC Urol 2022; 22:30. [PMID: 35255882 DOI: 10.1186/s12894-022-00985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Renal colic is a surgical emergency in pregnancy that is caused by a range of non-obstetric factors and known to occur more frequently during the second and third trimesters. Several studies have reported that up to 70–80% of stones pass spontaneously during pregnancy. There are some patients will not pass their stones and will ultimately require surgical intervention. Through retrospective analysis of the clinical data of 212 pregnant women with renal colic, the predictive factors of pregnant women with renal colic in need of surgical intervention were determined. Methods We conducted a retrospective review of 212 pregnant women presenting with renal colic between 1st January 2009 and 31st December 2020. Univariate and multivariate analyses identified a range of predictive variables for surgical intervention. In addition, we used receiver operating characteristic curve analysis to evaluate the predictive power of our model and created a nomogram for clinical application. Results Of the 212 patients presenting with acute renal colic in pregnancy, 100 patients (47.2%) underwent surgical intervention and 112 patients (52.8%) were treated conservatively. Univariate analysis identified significant differences between the two groups with regards to fever, the duration of pain, white blood cells, C-reactive protein, ureteral stone size, hydronephrosis, and stone location. Multivariate analysis further identified a number of independent predictors for surgical intervention, including fever, a duration of pain ≥ 4 days, a ureteral stone size ≥ 8 mm, and moderate or severe hydronephrosis. Conclusions We identified several independent predictors for surgical intervention for renal colic in pregnancy. Fever, a duration of pain ≥ 4 days, a ureteral stone size ≥ 8 mm, and moderate/severe hydronephrosis, play significant roles in predicting surgical intervention. Our nomogram can help to calculate the probability of surgical intervention in a simple and efficient manner. Prospective studies are now required to validate our model.
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Morsy S, Nasser I, Aboulela W, Abdelazim MS, Ali H. Efficacy of Mirabegron as Medical Expulsive Therapy for Distal Ureteral Stones: A Prospective, Randomized, Double-Blinded, Controlled Study. Urol Int 2022; 106:1265-1271. [PMID: 35100594 DOI: 10.1159/000521171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/21/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Today, medical expulsive therapy (MET) is more effective and commonly used in distal ureteral stones when compared with conservative treatments. Many treatments, namely, alpha-adrenergic blockers and calcium channel blockers, prostaglandin synthesis inhibitors, glyceryl trinitrate, and steroids, have been, therefore, utilized to mitigate such complications and accelerate stone expulsion. Several animal and human studies revealed the presence of β3-receptors in the ureter and bladder, where stimulating these receptors could relax the distal ureteral segment. OBJECTIVES The aim of the study was to evaluate the efficacy of use of mirabegron as MET for distal ureteral stones (intramural and extramural). METHODS This is a prospective randomized controlled study including 90 patients who had distal ureteral stones less than 10 mm and were evaluated between January and June 2020. The patients were classified into 3 groups: group (A) 30 patients: mirabegron 50 mg d-1 + diclofenac Na 100 mg tab (to be taken only during colic episodes), group (B) 30 patients: tamsulosin HCL 0.4 mg cap + diclofenac Na 100 mg tab (to be taken only during colic episodes), and group (C) 30 patients: diclofenac Na 100 mg tab only (to be taken only during colic episodes). Age, sex, stone size, laterality, and grade of ureterohydronephrosis were recorded. Patients were observed for 30 days, and ureteroscopy was completed for those with nonexpulsed stones. Follow-up parameters included number of renal colic episodes, duration of medical therapy, stone expulsion time, and stone expulsion rate (SER). RESULTS In the group (A), 2 (6.6%) patients were excluded due to nasal congestion, and 1 (3.3%) patient was excluded due to a 20-mm Hg systolic blood pressure increase. Four (13.3%) patients in group (B) were noncompliant on medical treatment. In addition, 2 (6.6%) patients in group (A), 1 (3.3%) patient in group (B), and 5 (16.6%) patients in group (C) who did not attend follow-up examinations were excluded from the study. The SER increased significantly in group (A) and (B) when compared with group (C). The mean time of stone expulsion was about 15, 25, and 12 days for groups A, B, and C, respectively, and there was a significant statistical difference (p value = 0.006) among the 3 groups. The mean number of renal colic episodes of group (A) of patients was 1.8 times, while that of group (B) was 2.6 times and that of group (C) was 2.16 times with no significant statistical difference after comparing the 3 groups (p value = 0.660). CONCLUSIONS Treatment with mirabegron appears to be a safe and effective medical expulsion therapy for distal ureteric stones and is better than tamsulosin.
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Affiliation(s)
- Samer Morsy
- Urology Department, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Islam Nasser
- Urology Department, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Waseem Aboulela
- Urology Department, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | | | - Hussein Ali
- Urology Department, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
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31
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He MM, Lin XT, Lei M, Xu XL, He ZH. Does delaying ureteral stent placement lead to higher rates of preoperative acute pyelonephritis during pregnancy? World J Clin Cases 2022; 10:802-810. [PMID: 35127896 PMCID: PMC8790458 DOI: 10.12998/wjcc.v10.i3.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/28/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pregnancy with renal colic may cause pyelonephritis, decreased renal function, systemic infection and even shock in pregnant women, and cause premature birth and other adverse pregnancy outcomes. When surgery is necessary, the relationship between timing of the operation and the outcome of the mother and child are not known.
AIM To investigate the association between time to ureteral stent placement and clinical outcomes of patients with renal colic during pregnancy.
METHODS In this retrospective study, pregnant women with renal colic who underwent surgery were studied. Maternal preoperative acute pyelonephritis (PANP), pregnancy outcome, and length of hospital stay (LOS) were compared between the two groups.
RESULTS 100 patients were included in the analysis, median age was 30 years. Median time to ureteral stent placement was 48 h (interquartile range, 25-96 h), and 32 patients (32%) were diagnosed with PANP. PANP was closely related to hospitalization costs, re-admission to the hospital due to urinary tract infection after surgery and premature delivery. Multivariate analysis found that stone location and time from pain to admission were related to PANP.
CONCLUSION Both early and delayed surgery are safe and effective for the treatment of renal colic during pregnancy. Early surgery may be superior to a delayed procedure due to shorter LOS. For pregnant patients with renal colic, delayed surgery within 48 h is not related to the clinical outcome of the mother and child. However, the time from pain to hospital admission was related to PANP.
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Affiliation(s)
- Mao-Mao He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China
| | - Xiao-Ting Lin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China
| | - Ming Lei
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China
| | - Xiao-Lan Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China
| | - Zhi-Hui He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China
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Juliebø-Jones P, Somani BK, Baug S, Beisland C, Ulvik Ø. Management of Kidney Stone Disease in Pregnancy: A Practical and Evidence-Based Approach. Curr Urol Rep 2022; 23:263-70. [PMID: 36197640 DOI: 10.1007/s11934-022-01112-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Suspected kidney stone disease during pregnancy is a difficult condition for health professionals to manage. This is partly due to the more limited range of diagnostic and therapeutic strategies, which can be safely applied. A comprehensive review of literature was performed to identify evidence to develop a practical guide to aid clinicians. RECENT FINDINGS Ultrasound remains the recommended first line option for imaging. Complicated cases, such as suspected infected obstructed system, require urgent decompression such as in the form of percutaneous nephrostomy. This article highlights the pharmacotherapeutic agents, which are considered safe for use in pregnancy. Where surgical intervention is indicated, evidence supports ureteroscopy to be a safe option as long as infection has been treated. Ureteroscopy can offer definitive clearance of the stone(s) and can be less burdensome regarding bothersome symptoms compared to indwelling ureteral stent or nephrostomy, which also require regular exchange due to the high propensity for encrustation in pregnancy. A multidisciplinary approach is fundamental to safely manage suspected kidney stone disease in pregnancy. Adoption of a locally agreed pathway as suggested in this article supports improved patient care.
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Savoie PH, Boissier R, Long JA. [ Renal colic: How to calm and optimize the stone expulsion? Which treatment for pregnant women and children?]. Prog Urol 2021; 31:956-966. [PMID: 34814989 DOI: 10.1016/j.purol.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/22/2021] [Accepted: 08/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aims of this narrative review was to report on the contemporary data of renal colic (RC) in terms of epidemiology and pressure on emergency structures and also to describe the latest therapeutic developments about uncomplicated RC, depending on the pediatric, adult and pregnancy population. MATERIAL AND METHODS A request to the health surveillance network for emergencies and deaths (SurSaUD®, Santé Publique France) revealed original data on the contemporary epidemiology of renal colic. A narrative synthesis of the articles (French, English) available on the Pubmed database was produced in June 2021. RESULTS Renal colic represents 1.1% of the annual total of emergency room visits. The mean age at admission was 45 years and 62% of patients were men. NSAIDs and Paracetamol are the most effective analgesic treatments and should be given priority over opioids. Non-drug analgesic treatments by tactile stimulation probably have a place in the CN management, particularly in case of contraindications. Among the validated treatments, alphablockers allow better expulsion when the stone is located in the pelvic ureter and if its size is between 5 and 10mm in diameter. In pregnant women, the predominant problem is to confirm the diagnostic. If there is a strong suspicion, MRI or a low-dose CT scan is possible. Ureteroscopy is feasible in particular in the first part of pregnancy to avoid iterative ureteral catheter changes. The care for children is now based on that of adults. CONCLUSION The renal colic care pathway in 2021 can benefit from various optimizations in the field of expulsion and analgesic treatments. Good knowledge of the specific situations in pregnant women and children allowing to improve the quality of care.
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Affiliation(s)
- P-H Savoie
- Hôpital d'instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 09, France.
| | - R Boissier
- Aix-Marseille université, service de chirurgie urologique et de transplantation rénale. CHU Conception, AP-HM, 13005 Marseille, France
| | - J-A Long
- Centre Hospitalier universitaire de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, La Tronche Cedex 9, France
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Moudane AE, Ahmed Y, Boukhannous I, Motaouakil A, Mokhtari M, Barki A. Acute renal infarction due to left ventricular thrombus: About a rare case and literature analysis. Urol Case Rep 2021; 40:101922. [PMID: 34778002 PMCID: PMC8577442 DOI: 10.1016/j.eucr.2021.101922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 12/04/2022] Open
Abstract
Renal infarction is a rare pathology, with a serious threat to the functional prognosis of the kidney. Because of its nonspecific clinic presentation, renal infarction is often misdiagnosed as renal colic and pyelonephritis or any etiology of abdominal pain. Embolic Renal infarction occurs commonly in a patient with the risk factors of thromboembolic with heart diseases especially atrial fibrillation. It's important to be aware of this condition to initiate treatment to increase the chance of renal salvage. We report a patient with a renal infarction due to the emboli from left ventricular thrombus with a brief review of the literature.
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Affiliation(s)
- Anouar El Moudane
- Department of Urology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, 62000, Morocco
| | - Yacoub Ahmed
- Department of Urology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, 62000, Morocco
| | - Ibrahim Boukhannous
- Department of Urology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, 62000, Morocco
| | - Abdessamade Motaouakil
- Department of Urology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, 62000, Morocco
| | - Mohamed Mokhtari
- Department of Urology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, 62000, Morocco
| | - Ali Barki
- Department of Urology, Mohamed VI University Hospital Center, Mohamed I University, Oujda, 62000, Morocco
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Innes GD, Teichman JMH, Scheuermeyer FX, McRae AD, Grafstein E, Andruchow J, Cheng L, Law MR. Does early intervention improve outcomes for patients with acute ureteral colic? CAN J EMERG MED 2021; 23:679-686. [PMID: 34491558 DOI: 10.1007/s43678-020-00016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Early surgical intervention is increasingly employed for patients with ureteral colic, but guidelines and current practice are variable. We compared 60-day outcomes for matched patients undergoing early intervention vs. spontaneous passage. METHODS This multicentre propensity-matched cohort analysis used administrative data and chart review to study all eligible emergency department (ED) patients with confirmed 2.0-9.9 mm ureteral stones. Those having planned stone intervention within 5 days comprised the intervention cohort. Controls attempting spontaneous passage were matched to intervention patients based on age, sex, stone width, stone location, hydronephrosis, ED site, ambulance arrival and acuity level. The primary outcome was treatment failure, defined as rescue intervention or hospitalization within 60 days, using a time to event analysis. Secondary outcome was ED revisit rate. RESULTS Among 1154 matched patients, early intervention did not reduce the risk of treatment failure (adjusted hazard ratio 0.94; P = 0.61). By 60 days, 21.8% of patients in both groups experienced the composite primary outcome (difference 0.0%; 95% confidence interval - 4.8 to 4.8%). Intervention patients required more hospitalizations (20.1% vs. 12.8%; difference 7.3%; 95% CI 3.0-11.5%) and ED revisits (36.1% vs. 25.5%; difference 10.6%; 95% CI 5.3-15.9%), but (insignificantly) fewer rescue interventions (18.9% vs. 21.3%; difference - 2.4%; 95% CI - 7.0 to 2.2%). CONCLUSIONS In matched patients with 2.0-9.9 mm ureteral stones, early intervention was associated with similar rates of treatment failure but greater patient morbidity, evidenced by hospitalizations and emergency revisits. Physicians should adopt a selective approach to interventional referral and consider that spontaneous passage probably provides better outcomes for many low-risk patients.
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Affiliation(s)
- Grant D Innes
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Room C231, Foothills Medical Centre, 1403, 29 Street NW, Calgary, AB, T2N 2T9, Canada.
| | - Joel M H Teichman
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine and Center for Healthcare Evaluation and Outcome Sciences, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D McRae
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Room C231, Foothills Medical Centre, 1403, 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Eric Grafstein
- Department of Emergency Medicine and Center for Healthcare Evaluation and Outcome Sciences, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - James Andruchow
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Room C231, Foothills Medical Centre, 1403, 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Innes GD, Wishart I, Lau T, Islam A, Gourlay K, Scheuermeyer FX. Can plain film radiography improve the emergency department detection of clinically important urinary stones? Am J Emerg Med 2021; 50:449-54. [PMID: 34492590 DOI: 10.1016/j.ajem.2021.08.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Physicians frequently use ultrasound to assess hydronephrosis in patients with suspected renal colic, but ultrasound has limited diagnostic sensitivity and rarely clarifies stone size or location. Consequently, up to 80% of emergency department (ED) renal colic patients undergo confirmatory CT imaging. Our goal was to estimate x-ray sensitivity for urinary stones and determine whether x-ray substantially improves stone detection (sensitivity) compared to hydronephrosis assessment alone. METHODS We reviewed imaging reports from all renal colic patients who underwent x-ray and CT at four EDs. For each patient, we documented stone size, location and hydronephrosis severity on CT and whether stones were identified on x-ray. We considered moderate and severe hydronephrosis (MS-Hydro) as significant positive findings, then calculated the sensitivity (detection rate) of MS-Hydro and x-ray for large stones ≥5 mm and for stones likely to require intervention (all ureteral stones >7 mm and proximal or middle stones >5 mm). We then tested a diagnostic algorithm adding x-ray to hydronephrosis assessment. RESULTS Among 1026 patients with 1527 stones, MS-Hydro sensitivity was 39% for large stones and 60% for interventional stones. X-ray sensitivity was 46% for large stones and 52% for interventional stones. Adding x-ray to hydronephrosis assessment increased sensitivity in all stone categories, specifically from 39% to 68% for large stones (gain = 29%; 95%CI, 23% to 35%) and from 60% to 82% for interventional stones (gain = 22%; 95%CI, 13% to 30%). Because CT and ultrasound show strong agreement for MS-Hydro identification, physicians who depend on ultrasound-based hydronephrosis assessment could achieve similar gains by adding x-ray. CONCLUSIONS Adding x-ray to hydronephrosis assessment substantially improves diagnostic sensitivity, enabling the detection of nearly 70% of large stones and over 80% of interventional stones. This level of sensitivity may be sufficient to reassure physicians about a renal colic diagnosis without CT imaging for many patients.
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Abstract
INTRODUCTION To report the epidemiology and the care pathway for urological emergencies in France for the official report of the 115th Congres Francais d'Urologie. METHODS We made a request to the Institut de Veille Sanitaire and its network Surveillance Sanitaire des Urgences et des Décès (SurSaUD®). Within this system, the OSCOUR® network (Organisation de la surveillance coordonnée des urgences) centralizes in real time the data of emergency visits from more than 720 emergency departments throughout the national territory (>93% of the national territory covered by the OSCOUR® network). For each emergency defined by its CIM-10 code, the following data were collected from 2014 to 2019: age, gender, length of stay and post-emergency status (hospitalization vs. return home). RESULTS From 2014 to 2019, urological emergencies represented on average 4.2% of all emergencies, with an average 591,080±66,782 passages/year including 25% that resulted in hospitalization. Infectious disease represented 35% of all urological emergencies. The 3 most common urologic emergencies were: renal colic, acute urine retention and hematuria for men; acute cystitis, pyelonephritis and renal colic for women. CONCLUSION In an analysis of the OSCOUR® (Organisation de la surveillance coordonnée des urgences) registry, we determined the epidemiological profiles of the main urological emergencies with contemporary data.
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Affiliation(s)
- R Boissier
- Université Aix-Marseille, Service d'Urologie et de transplantation Rénale, CHU La Conception, AP-HM, Marseille, France.
| | - P H Savoie
- Service d'urologie, Hôpital d'Instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 09, France
| | - J-A Long
- Service d'urologie et de la transplantation rénale, CHU Grenoble, France; TIMC-IMAG CNRS 5525, France
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Abi Tayeh G, Safa A, Sarkis J, Alkassis M, Khalil N, Nemr E, El Helou E. Determinants of pyelonephritis onset in patients with obstructive urolithiasis. Urologia 2021; 89:100-103. [PMID: 34338097 DOI: 10.1177/03915603211035244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute obstructive pyelonephritis due to urolithiasis represents a medico-surgical emergency that can lead to life-threatening complications. There are still no established factors that reliably predict progression toward acute pyelonephritis in patients presenting with a simple renal colic. OBJECTIVE To investigate clinical and paraclinical factors that are associated with the onset of acute obstructive pyelonephritis. METHODS Patients presenting to the emergency department for renal colic with obstructive urolithiasis on imaging were enrolled in the study. Demographic data, vital signs, medical comorbidities, blood test results, urinalysis, and radiological findings were recorded. Obstructive pyelonephritis was defined by the presence of two or more of the following criteria: fever, flank pain or costovertebral angle tenderness, and a positive urine culture. RESULTS Seventeen patients out of 120 presenting with renal colic, were diagnosed with acute obstructive pyelonephritis (14%). Parameters that were associated with the onset of obstructive pyelonephritis were: diabetes (p = 0.03), elevated CRP (p = 0.01), stone size (>5 mm) (p = 0.03), dilatation of renal pelvis (p = 0.01), peri-renal fat stranding (p = 0.02), and positive nitrites on urinalysis (p < 0.01). Hyperleukocytosis, acute kidney injury, multiple stones, pyuria (>10/mm3), hypertension, and were not associated with the onset of obstructive pyelonephritis. CONCLUSION This study showed that known diabetic status, elevated CRP, positive urine nitrites, stone size (>5 mm), pyelic dilatation, and peri-renal fat stranding were associated with the onset of pyelonephritis in patients presenting to the emergency department with obstructive urolithiasis.
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Affiliation(s)
- Georges Abi Tayeh
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Ali Safa
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Julien Sarkis
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Marwan Alkassis
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Nour Khalil
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Elie Nemr
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
| | - Elie El Helou
- Department of Urology, Hotel Dieu de France Hospital, University of Saint Joseph, Beirut, Lebanon
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Innes GD, Scheuermeyer FX, McRae AD, Teichman JMH, Lane DJ. Hydronephrosis severity clarifies prognosis and guides management for emergency department patients with acute ureteral colic. CAN J EMERG MED 2021; 23:687-695. [PMID: 34304393 DOI: 10.1007/s43678-021-00168-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In emergency department patients with ureteral colic, the prognostic value of hydronephrosis is unclear. Our goal was to determine whether hydronephrosis can differentiate low-risk patients appropriate for trial of spontaneous passage from those with clinically important stones likely to experience passage failure. METHODS We used administrative data and structured chart review to evaluate a consecutive cohort of patients with ureteral stones who had a CT at nine Canadian hospitals in two cities. We used CT, the gold standard for stone imaging, to assess hydronephrosis and stone size. We described classification accuracy of hydronephrosis severity for detecting large (≥ 5 mm) stones. In patients attempting spontaneous passage we used hierarchical Bayesian regression to determine the association of hydronephrosis with passage failure, defined by the need for rescue intervention within 60 days. To illustrate prognostic utility, we reported pre-test probability of passage failure among all eligible patients (without hydronephrosis guidance) to post-test probability of passage failure in each hydronephrosis group. RESULTS Of 3251 patients, 70% male and mean age 51, 38% had a large stone, including 23%, 29%, 53% and 72% with absent, mild, moderate and severe hydronephrosis. Passage failure rates were 15%, 20%, 28% and 43% in the respective hydronephrosis categories, and 23% overall. "Absent or mild" hydronephrosis identified a large subset of patients (64%) with low passage failure rates. Moderate hydronephrosis predicted slightly higher, and severe hydronephrosis substantially higher passage failure risk. CONCLUSIONS Absent and mild hydronephrosis identify low-risk patients unlikely to experience passage failure, who may be appropriate for trial of spontaneous passage without CT imaging. Moderate hydronephrosis is weakly associated with larger stones but not with significantly greater passage failure. Severe hydronephrosis is an important finding that warrants definitive imaging and referral. Differentiating "moderate-severe" from "absent-mild" hydronephrosis provides risk stratification value. More granular hydronephrosis grading is not prognostically helpful.
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Affiliation(s)
- Grant D Innes
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D McRae
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Joel M H Teichman
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Daniel J Lane
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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Li C, Guo L, Luo M, Guo M, Li J, Zhang S, Liu G. Risk factors of uterine contraction after ureteroscopy in pregnant women with renal colic. Int Urol Nephrol 2021; 53:1987-1993. [PMID: 34227015 PMCID: PMC8463365 DOI: 10.1007/s11255-021-02932-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
Background Ureteroscopy is widely applied in pregnant women with renal colic, but such patients are easy to experience uterine contraction after surgery. There are many factors which may affect uterine contraction, this study aims to explore the risk factors of uterine contraction triggered by ureteroscopy in pregnant women with renal colic. Methods One hundred and one pregnant women were retrospectively analyzed, the patients were hospitalized because of severe renal colic. All patients received ureteroscopy during which double J catheters were inserted into ureters for drainage. Patients received other medical treatments individually according to their condition and uterine contractions were detected by EHG within 12 h after operation. Patients were classified as group A (uterine contraction) and group B (no uterine contraction) according to the presence or absence of continuously regular uterine contraction. Clinical characteristics were collected for further analysis, including history of childbirth, anesthesia method, application of phloroglucinol or not, operation time, Oxygen inhalation or not, pain relief or not after surgery, systemic inflammatory response syndrome (SIRS) occurred or not. A binary logistic regression analysis model was established to explore whether such clinical characteristics were relevant to uterine contraction after ureteroscopy. Results Continuously regular uterine contraction presented in 46 pregnant women within 12 h after ureteroscopy, making the incidence of uterine contraction as high as 45.54%. The presence of uterine contraction was related to the following factors(P < 0.05): history of childbirth (primipara versus multipara)(OR 6.593, 95% CI 2.231–19.490), operation time (each quarter additional) (OR 2.385, 95% CI 1.342–4.238), application of phloroglucinol (yes versus not) (OR 6.959, 95% CI 1.416–34.194), pain relief after surgery(yes versus not)(OR 6.707, 95% CI 1.978–22.738), SIRS occurred after surgery (yes versus not) (OR 0.099, 95% CI 0.014–0.713). Conclusion Continuously regular uterine contraction is easy to occur within 12 h after ureteroscopy in pregnant women. SIRS occurred after surgery is a risk factor for uterine contraction; on the contrary, no history of childbirth, shorter operation time, application of phloroglucinol, pain relief after surgery are protective factors.
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Affiliation(s)
- Chunjing Li
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China.
| | - Liwen Guo
- Department of Gynecology, Ningde Municipal Hospital, Fujian Medical University, Ningde, Fujian, 352100, People's Republic of China
| | - Mi Luo
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China
| | - Mingjuan Guo
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China
| | - Jierong Li
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China
| | - Shilin Zhang
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China
| | - Guoqing Liu
- Department of Urology, Affiliated Foshan Maternal and Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, 528000, People's Republic of China.
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Symeonidis EN, Memmos D, Langas G, Bouchalakis A, Baniotis P, Savvides E, Stefanidis P, Mutomba WF, Dimitriadis G. Incidental discovery of endourethral clip migration 10 years after radical prostatectomy: A case report and review of the literature. Urologia 2021; 89:136-141. [PMID: 33715533 DOI: 10.1177/03915603211001177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Surgical clips (SCs) have been widely used for a variety of surgical procedures over the years. Despite their advantages and proven effectiveness, several clip-related complications have been reported, creating dilemmas as to their optimal use. CASE DESCRIPTION Herein, we present a rare delayed and incidental discovery of two endourethral metallic SCs in a 77-year-old male seeking treatment for acute renal colic. The patient had undergone open radical retropubic prostatectomy 10 years ago, and had an uneventful postoperative recovery. Computed tomography scan revealed left-sided hydronephrosis secondary to proximal ureteral calculus, as well as SCs at the level of vesico-urethral (VUR) anastomosis. Flexible cystoscopy confirmed the imaging findings, showing two endourethral clips, partly obstructing the VUR. Firstly, a serial wire-guided dilation took place, followed by left ureteral double-J stent placement. Unfortunately, the clips could not be concurrently removed due to their firm attachment to the bladder neck. Hence, our patient was scheduled for transurethral resection of the bladder neck and simultaneous endoscopic clip removal. CONCLUSIONS To the best of our knowledge, this is the first report to highlight such a delayed incidental finding, 10 years after open retropubic radical prostatectomy (RRP), during a JJ stent insertion for obstructive uropathy without previous clip-induced lower urinary tract symptoms. Although rare, physicians should be aware of the potential clip-related complications arising either in the short- or long-term postprostatectomy setting.
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Affiliation(s)
- Evangelos N Symeonidis
- First Department of Urology, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Dimitrios Memmos
- First Department of Urology, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Georgios Langas
- First Department of Urology, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Athanasios Bouchalakis
- First Department of Urology, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Panagiotis Baniotis
- First Department of Urology, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Eliophotos Savvides
- First Department of Urology, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Panagiotis Stefanidis
- First Department of Urology, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Wilbert F Mutomba
- First Department of Urology, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Georgios Dimitriadis
- First Department of Urology, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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Gourlay K, Splinter G, Hayward J, Innes G. Does pain severity predict stone characteristics or outcomes in emergency department patients with acute renal colic? Am J Emerg Med 2021; 45:37-41. [PMID: 33647760 DOI: 10.1016/j.ajem.2021.02.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES After initial emergency department (ED) management of acute renal colic, recurrent or ongoing severe pain is the usual pathway to ED revisits, hospitalizations and rescue interventions. If index visit pain severity is associated with stone size or with subsequent failure of conservative management, then it might be useful in identifying patients who would benefit from early definitive imaging or intervention. Our objectives were to determine whether pain severity correlates with stone size, and to evaluate its utility in predicting important outcomes. METHODS We used administrative data and structured chart review to study all ED patients with CT proven renal colic at six hospitals in two cities over one-year. Triage nurses recorded arrival numeric rating scale (NRS) pain scores. We excluded patients with missing pain assessments and stratified eligible patients into severe (NRS 8-10) and less-severe pain groups. Stone parameters were abstracted from imaging reports, while hospitalizations and interventions were identified in hospital databases. We determined the classification accuracy of pain severity for stones >5mm and used multivariable regression to determine the association of pain severity with 60-day treatment failure, defined by hospitalization or rescue intervention. RESULTS We studied 2206 patients, 68% male, with a mean age of 49 years. Severe pain was 52.0% sensitive and 45.3% specific for larger stones >5mm. After multivariable adjustment, we found a weak negative association (adjusted OR =0.96) between pain severity and stone width. For each unit of increasing pain, the odds of a larger stone fell by 4%. Index visit pain severity was not associated with the need for hospitalization or rescue intervention within 60-days. CONCLUSIONS Pain severity is not helpful in predicting stone size or renal colic outcomes. More severe pain does not indicate a larger stone or a worse prognosis.
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Affiliation(s)
- Katie Gourlay
- The University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada
| | - Graeme Splinter
- The University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada
| | - Jake Hayward
- Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 112 street, Edmonton T6G 2T4, Canada
| | - Grant Innes
- Departments of Emergency Medicine and Community Health Services, University of Calgary, 2500 University Drive NW, Calgary T2N 1N4, Canada.
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Mohammadinejad P, Ferrero A, Bartlett DJ, Khandelwal A, Marcus R, Lieske JC, Moen TR, Mara KC, Enders FT, McCollough CH, Fletcher JG. Automated radiomic analysis of CT images to predict likelihood of spontaneous passage of symptomatic renal stones. Emerg Radiol 2021; 28:781-8. [PMID: 33644833 DOI: 10.1007/s10140-021-01915-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the ability of a semi-automated radiomic analysis software in predicting the likelihood of spontaneous passage of urinary stones compared with manual measurements. METHODS Symptomatic patients visiting the emergency department with suspected stones in either kidney or ureters who underwent a CT scan were included. Patients were followed for up to 6 months for the outcome of a trial of passage. Maximum stone diameters in axial and coronal images were measured manually. Stone length, width, height, max diameter, volume, the mean and standard deviation of the Hounsfield units, and morphologic features were also measured using automated radiomic analysis software. Multivariate models were developed using these data to predict subsequent spontaneous stone passage, with results expressed as the area under a receiver operating curve (AUC). RESULTS One hundred eighty-four patients (69 females) with a median age of 56 years were included. Spontaneous stone passage occurred in 114 patients (62%). Univariate analysis demonstrated an AUC of 0.83 and 0.82 for the maximum stone diameter determined manually in the axial and coronal planes, respectively. Multivariate models demonstrated an AUC of 0.82 for a model including manual measurement of maximum stone diameter in axial and coronal planes. The same AUC was found for a model including automatic measurement of maximum height and diameter of the stone. Further addition of morphological parameters measured automatically did not increase AUC beyond 0.83. CONCLUSION The semi-automated radiomic analysis of urinary stones shows similar accuracy compared with manual measurements for predicting urinary stone passage. Further studies are needed to predict clinical impacts of reporting the likelihood of urinary stone passage and improving inter-observer variation using automatic radiomic analysis software.
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González-Padilla DA, González-Díaz A, García-Rojo E, Abad-López P, Santos-Pérez de la Blanca R, Hernández-Arroyo M, Teigell-Tobar J, Peña-Vallejo H, Rodríguez-Antolín A, Cabrera-Meirás F. Analgesic refractory colic pain: Is prolonged conservative management appropriate? Am J Emerg Med 2021; 44:137-142. [PMID: 33618037 DOI: 10.1016/j.ajem.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To propose a clear definition and management pathway of patients with analgesic refractory colic pain (ARCP). PATIENTS AND METHODS Prospective cohort study from February 2018 to February 2019 including patients with ARCP defined as ongoing renal colic pain after one dose of IV NSAID, IV paracetamol, and a parenteral opioid, given sequentially in that order. Patients were observed in-hospital under full parenteral analgesic management for 8-12 h, whenever patients had minimal or absent pain after conservative management (CM) they were discharged, and followed-up with new imaging within four weeks. If the pain was not controlled after CM, surgical management (double-J stent or ureteroscopy) was performed. We excluded patients with any other indication for urgent intervention or in cases where CM was deemed inappropriate (sepsis, acute renal failure, stones >10 mm in size, suspected concomitant urinary tract infection, bilateral ureteral stones, pregnancy, patients with a single kidney, kidney transplant recipients, difficult access to medical care or refusal to undergo CM). RESULTS Data from 60 patients was collected. The only variable associated with an increased risk of failed CM was a history of previous renal colic (OR 3.98 [95% CI 1.14-13.84], p = 0.02). Neither gender, age, stone size, location, or hydronephrosis grade were able to predict CM failure. 41.6% of patients were successfully managed conservatively and only 8% of them required scheduled surgical management at follow-up. CONCLUSION Our results show that a high proportion of patients with ARCP may be successfully managed conservatively with an extended observation period without complications at follow-up. These results should be replicated in a randomized controlled trial to confirm them.
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Affiliation(s)
- Daniel A González-Padilla
- Department of Urology, University Hospital 12 de Octubre, Madrid, Spain; Department of Urology, University Hospital Infanta Sofía, Madrid, Spain.
| | | | | | - Pablo Abad-López
- Department of Urology, University Hospital 12 de Octubre, Madrid, Spain
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Ghoshal N, Gaikstas G. CT KUB scans for renal colic: Optimisation of scan range to reduce patient radiation burden. Radiography (Lond) 2021; 27:784-788. [PMID: 33451884 DOI: 10.1016/j.radi.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Non-contrast CT KUB scans performed to assess renal colic should be limited to scanning between the upper pole of the highest kidney and the pubic symphysis to minimise unnecessary irradiation. This audit aimed to assess the amount of overscanning in CT KUBs outside this range. METHODS CT KUB scans taken over a 10-day period were assessed. Unnecessary overscan above the highest kidney was measured as a percentage of the total scan range. A target of less than 10% overscanning was set. The vertebral position of the upper pole of the highest kidney was also measured and compared to the actual level of the scan. RESULTS 88 patients were assessed. 89.8% (79/88) of scans didn't meet the target of less than 10% overscanning above the highest kidney, and were associated with a higher radiation dose to the patient. The average overscanning above the highest pole of the kidney was 16.4% of the whole scan. The average overscan below the pubic symphysis was 1.54%. We also found that 100% of scanned kidneys lied below the upper border of the T11 vertebra, in spite of scans starting as high as T7. CONCLUSION A large proportion of scans included unnecessary overscanning above the highest kidney. We have identified the upper border of the T11 vertebral body as a potential location from which to begin the upper margin of a CT KUB scan. IMPLICATIONS FOR PRACTICE By starting CT KUB scans at the upper border of the T11 vertebral body, we can allow the whole kidney to be imaged while minimising unnecessary overscanning above the kidney, thus lowering excess patient irradiation while still producing high quality scans.
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Lim HJ, Hwang JH, Kim JH, Park S, Lee KH, Park SH. Spontaneous renal artery thrombosis: A rare cause of acute flank pain. Radiol Case Rep 2021; 16:9-12. [PMID: 33144903 DOI: 10.1016/j.radcr.2020.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/14/2020] [Accepted: 10/17/2020] [Indexed: 12/20/2022] Open
Abstract
Spontaneous renal artery thrombosis is a rare cause of flank pain and can have fatal consequences. We report a case of acute renal artery thrombosis in a 61-year-old man who experienced flank pain and had no medical history. A contrast-enhanced computed tomography scan revealed total thrombotic occlusion of the left renal artery. The patient was taken to interventional radiology, and an urgent catheter-directed thrombolysis of the renal artery was performed. The procedure was successful, with the subsequent arteriogram demonstrating a substantial decrease of the thrombus extent and the recanalization of the left renal artery. This case highlights that emergency renal artery thrombolysis is an effective and safe treatment for acute occlusion of the renal artery.
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Qu LG, Chan G, Gani J. Clinician training level impacts prescribing practices for the conservative management of acute renal colic: a contemporary update. Int Urol Nephrol 2020; 53:661-667. [PMID: 33104951 DOI: 10.1007/s11255-020-02686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Given the current and increasing awareness of the opioid crisis, this study aimed to characterise the types of analgesic prescription for conservatively managed renal colic. METHODS This was a retrospective cohort study of consecutive patients presenting to the Emergency Department (ED) in 2014-2019. Patients were included if they had radiographically confirmed obstructing calculus, managed conservatively without intervention, and were given a prescription for analgesia on discharge. Patient demographics were recorded and analysed. Opioid, non-opioid, and alpha-blocker medications were compared according to patient and disease parameters, and clinician training. Oral morphine equivalents (OMEs) were used to compare prescribed quantities. Subgroup analyses of stone size and location were performed. RESULTS Our analysis included 1761 patients with confirmed renal colic: median age of 50 years (16-96). Altogether, 88% of included patients were prescribed opioids on discharge, while only 68% were prescribed non-opioids (p < 0.001). Oxycodone immediate release was the most frequently prescribed analgesic. Logistic regression modelling controlling for patient and disease characteristics significantly predicted more non-opioid (p < 0.001) and alpha-blocker (p = 0.037) prescription with clinician training < 3 years. Linear regression modelling demonstrated that clinicians training < 3 years predicted lower OMEs per prescription compared to clinicians with ≥ 3 years of training (p = 0.001). Subgroup analyses supported similar predictions with training. CONCLUSIONS Prescribing patterns are associated with different clinician experience levels. However, a substantial amount of opioids are still given overall on patient discharge regardless of the clinician experience. Educational interventions aimed at reducing the opioid prescription rate and quantities may be considered for clinicians of all training levels.
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Affiliation(s)
- Liang G Qu
- Department of Urology, Austin Health, 145-161 Studley Rd, Heidelberg, VIC, 3084, Australia. .,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.
| | - Garson Chan
- Department of Urology, Austin Health, 145-161 Studley Rd, Heidelberg, VIC, 3084, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Surgery, University of Saskatchewan, Saskatchewan, Canada
| | - Johan Gani
- Department of Urology, Austin Health, 145-161 Studley Rd, Heidelberg, VIC, 3084, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Department of Urology, Western Health, Footscray, VIC, Australia
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Kadioglu E, Kaya M, Yildirim H. Transversus abdominis plane block: A new method in renal colic pain management. Am J Emerg Med 2020; 38:2116-2118. [PMID: 33071076 DOI: 10.1016/j.ajem.2020.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022] Open
Abstract
In recent decades, regional plane blocks via ultrasonography have become very popular in regional anesthesia and are more commonly used in pain management. The transversus abdominis plane (TAP) block is a procedure where local anesthetics are applied to block the anterior divisions of the tenth thoracic intercostal through the first lumbar nerves (T10-L1) into the anatomic space formed amidst the internal oblique and transversus abdominis muscles located in the antero-lateral part of the abdomen wall. The most important advantage of this block method is that ultrasonographic identification is easier and its complications are fewer compared with central neuroaxial or paravertebral blocks. Here, we describe three cases where pain management in renal colic was treated with the TAP block.
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Affiliation(s)
- Emine Kadioglu
- University of Kutahya Health Sciences, Medical Scholl, Department of Emergency Medicine, Kutahya, Turkey.
| | - Murtaza Kaya
- University of Kutahya Health Sciences, Medical Scholl, Department of Emergency Medicine, Kutahya, Turkey.
| | - Harun Yildirim
- University of Kutahya Health Sciences, Medical Scholl, Department of Emergency Medicine, Kutahya, Turkey.
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Faget C, Millet I, Sebbane M, Thuret R, Verheyden C, Curros-Doyon F, Molinari N, Taourel P. Imaging strategies for patients with suspicion of uncomplicated colic pain: diagnostic accuracy and management assessment. Eur Radiol 2020; 31:2983-2993. [PMID: 33051735 DOI: 10.1007/s00330-020-07264-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/15/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Compare different imaging scenarios in the diagnosis of uncomplicated renal colic due to urolithiasis (URCU). MATERIALS AND METHODS A total of 206 prospectively included patients had been admitted with suspected URCU and had undergone abdominal plain film (APF), US and unenhanced CT after clinical STONE score evaluation. CT was the reference standard. We assessed sensitivity (Se), specificity (Spe) and Youden index for colic pain diagnosis, percentage of patients managed by urologic treatment with stone identified, percentage of alternative diagnoses (AD) and exposure to radiation, according to single imaging approaches, strategies driven by patient characteristics and conditional imaging strategies after APF and US. RESULTS One hundred (48.5%) patients had a final diagnosis of URCU and 19 underwent urologic treatment. The conditional strategy, i.e. CT in patients who had no stone identified at US, had a perfect sensitivity and specificity. This enabled diagnosis of all stones requiring urology management while decreasing the number of CT exams by 22%. The strategy whereby CT was used when there was neither direct or indirect APF + US finding of colic pain nor alternative diagnoses in patients with a STONE score ≥ 10 had a sensitivity of 0.95 and a specificity of 0.99, identified 84% of stones managed by urologic treatment and decreased the number of CT examinations by 76%. CONCLUSION In patients with clinical findings consistent with URCU, the use of ultrasound as first-line imaging modality, with CT restricted to patients with negative US and a STONE score ≥ 10, led to a sensitivity and specificity of above 95%, identified 84% of stones requiring urological management and reduced the number of CT scans needed by fourfold. KEY POINTS • For diagnosis, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, provides both a sensitivity and specificity superior or equal to 95% and reduces the number of CT scans necessary by fourfold. • For management, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, maintains a 84% stone identification rate in urology-treated patients.
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Affiliation(s)
- Claire Faget
- Department of Medical Imaging, Montpellier University Hospital, Lapeyronie Hospital, 191, Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Ingrid Millet
- Department of Medical Imaging, Montpellier University Hospital, Lapeyronie Hospital, 191, Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Mustapha Sebbane
- Department of Emergency, Montpellier University Hospital, Lapeyronie Hospital, Montpellier, France
| | - Rodolphe Thuret
- Department of Urology and Renal Transplantation, Montpellier University Hospital, Lapeyronie Hospital, Montpellier, France
| | - Cécile Verheyden
- Department of Medical Imaging, Montpellier University Hospital, Lapeyronie Hospital, 191, Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Fernanda Curros-Doyon
- Department of Medical Imaging, Montpellier University Hospital, Lapeyronie Hospital, 191, Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Nicolas Molinari
- Department of Biostatistics and Medical Information, Montpellier University Hospital, Lapeyronie Hospital, Montpellier, France
| | - Patrice Taourel
- Department of Medical Imaging, Montpellier University Hospital, Lapeyronie Hospital, 191, Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
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50
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Rodrigues Gaspar JR, Vieira E Monteiro E, Costa Simões VJ, Durão Salgueiro PS. Renal Colic by Gastrointestinal Perforation: Endoscopic Approach. GE Port J Gastroenterol 2020; 28:222-224. [PMID: 34056049 DOI: 10.1159/000510033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Joana Raquel Rodrigues Gaspar
- Department of Surgery, General Surgery, Centro Hospitalar e Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Eunice Vieira E Monteiro
- Department of Surgery, General Surgery, Centro Hospitalar e Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Vítor José Costa Simões
- Department of Surgery, General Surgery, Centro Hospitalar e Universitário do Porto-Hospital de Santo António, Porto, Portugal
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