Ureteral catheterization in uncomplicated ureterolithotripsy: a randomized, controlled trial.
ABSTRACT To evaluate short-term ureteral catheterization in patients undergoing ureteroscopic lithotripsy for ureteral calculi.
Patients (n = 140) with ureteral calculi who were candidates for ureterolithotripsy were enrolled. Stone size was 5-10mm. The operation was performed with an 8-9.8F semirigid ureteroscope without active dilatation and stones were fragmented with a 1F pneumatic lithotrite. Uncomplicated cases (109 patients) were randomized to catheterized (C) and noncatheterized (NC) groups. In the 54 C group patients, a polyurethane catheter (5F) was passed through the ureter after lithotripsy with the end attached to a Foley placed in urethra, which was removed after 24h. Postoperatively, all patients were evaluated for flank and suprapubic pain, renal colic, irritative urinary symptoms, peritonism, frequency of analgesic usage, urinary tract infection, duration of hospitalization, postdischarge visits (due to renal colic/pain), readmission, and residual stone rates.
On the first postoperative day, the percentage of patients experiencing flank pain and renal colic was significantly higher in the NC group (76% and 45%) compared with the C group (20% and 2%); 67% of NC patients required analgesic administration during hospital stay versus 20% of C patients (p<0.001). Suprapubic pain and urethral irritation were reported by 13% and 37% of C patients, respectively, and 5% and 4% of NC patients. However, peritonism was developed more often in NC patients (27% vs. 13%). Hospital stay was 1 d for all patients. Three days postoperatively, 40% of NC patients complained of at least one episode of flank pain compared with 7% of C patients (p<0.001). Incidence of urinary tract infections was 4% in NC and 7% in C group patients. Postdischarge visits were necessary in 20% of NC patients and 5% of C patients. No patient in either group required readmission. No complaints were reported nor residual stones discovered on 2-wk follow-up radiographs in either group.
Short-term ureteral catheterization in uncomplicated ureteroscopy and lithotripsy has a role in reducing early postoperative morbidities. It may also decrease pain and colic after discharge.
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ABSTRACT: To review our 5-year experience with retrograde ureteroscopic treatment for patients with upper ureteral stones and to compare the outcome, safety, and efficiency of pneumatic and holmium laser lithotripsy in managing upper ureteral stones. We retrospectively analyzed the hospital records of 372 patients who underwent 384 retrograde ureteroscopic procedures for upper ureteral stones at our center from January 2003 to December 2007. Patient and stone characteristics, treatment variables. and clinical outcomes were assessed. Factors such as failure of the procedure, stone clearance, intraoperative and postoperative morbidity, procedure duration, and hospital stay were analyzed and compared between pneumatic (group 1) and laser lithotripsy (group 2). Overall, the stone-free rate was 90.4%, the mean operative duration was 41.2 ± 10.7 minutes, the mean postoperative hospital stay was 2.7 ± 0.9 days, and the rates of intraoperative and postoperative complications were 14.6% and 3.9%, respectively, for groups 1 and 2. In comparing group 1 and group 2, the significantly higher number of intraoperative complications coincide with a significantly lower stone-free rate. Nevertheless, the incidence of intraoperative and postoperative complications between the two groups was not statistically significant except in the case of stone upward migration. The mean operative time of group 2 was 43.3 ± 11.1 minutes, which was significantly longer than that for group 1, which was 38.7 ± 9.1 minutes (P < 0.05). Retrograde ureteroscopy is a safe and effective method for managing upper ureteral stones. A high postoperative stone-free rate is associated with the refined use of a holmium laser lithotriptor to ensure thoroughness while avoiding migration of the stones into the renal pelvis. Although laser lithotripsy has a longer operative time, it remains the more appropriate choice for managing upper ureteral stones.Journal of endourology / Endourological Society 11/2010; 24(11):1753-7. · 1.75 Impact Factor
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ABSTRACT: To observe the influence of operating urologist's education and adopted skills on the outcome of ureterorenoscopy treatment of ureteral stones. The study included 422 patients (234 men, 55.4%) who underwent ureterorenoscopy to treat ureteral stones at the Urology Department of Clinical Hospital Center Split, Croatia, between 2001 and 2009. All interventions were carried out with a semi-rigid Wolf ureteroscope and an electropneumatic generator used for lithotripsy. The operating specialists were divided into two groups. The first group included 4 urologists who had started learning and performing endoscopic procedures at the beginning of their specialization and the second group included 4 urologists who had started performing endoscopic procedures later in their careers, on average more than 5 years after specialization. Radiology tests confirmed that 87% (208/238) of stones were completely removed from the distal ureter, 54% (66/123) from the middle ureter, and 46% (28/61) from the proximal ureter. The first group of urologists completed significantly more procedures successfully, especially for the stones in the distal (95% vs 74%; P = 0.001) and middle ureter (66% vs 38%; P = 0.002), and their patients spent less time in the hospital postoperatively. Urologists who started learning and performing endoscopic procedures at the beginning of their specialization are more successful in performing ureteroscopy. It is important that young specialists receive timely and systematic education and cooperate with more experienced colleagues.Croatian Medical Journal 02/2011; 52(1):55-60. · 1.25 Impact Factor
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ABSTRACT: RESUMO Pacientes com cálculo ureteral tipicamente apresentam cólica renal consequente à obstrução do trato urinário. Uma vez controlada a crise dolorosa, um plano terapêutico deve ser estabelecido. A tomografia computadorizada (TC) helicoidal de abdômen e pelve sem contraste endovenoso é o exame de imagem de eleição. O tratamento da litíase ureteral pode ser conservador ou interventivo. Bloqueadores alfa-adrenérgicos são as drogas mais utilizadas para o tratamento clínico expulsivo. Para cálculos com pequena probabilidade de eliminação espontânea devido ao seu tamanho e/ou localização, indica-se tratamento interventivo, realizado através de litotripsia extracorpórea por ondas de choque, endourologia ou excepcionalmente através de cirurgia, aberta ou laparoscópica. A urgência da intervenção é maior em casos de obstrução e infecção do trato urinário superior, impondo deterioração da função renal, dor ou vômitos, anúria ou severo grau de obstrução em rim único ou transplantado. A melhor modalidade terapêutica a ser empregada deve ser individualizada. ABSTRACT Patients with ureteral calculi typically present renal colic due to urinary tract obstruction. Once the acute pain is controlled a therapeutic plan should be established. The unenhanced CT is the best diagnostic test. Ureteral calculi treatment can be either clinical or interventive. Alpha-adrenergic blockers are the most frequently prescribed drugs for the so-called medical expulsion therapy. Stones with a low probability of spontaneous passage (on the basis of their size and location) should be treated using such interventions as extracorporeal shock wave lithotripsy, ureteroscopy, or open surgery, in selected cases. Urgent intervention is indicated for a patient with an obstructed, infected upper urinary tract, impending renal deterioration, intractable pain or vomiting, anuria, or high-grade obstruction in a solitary or transplanted kidney. The best therapeutic approach should be selected on an individual basis.Jornal Brasileiro de Nefrologia. 01/2009;