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 evaluate the safety and effectiveness of ureteroscopic stone manipulation, we retrospectively reviewed the failure and complication rates of two series of retrograde ureteroscopies (URS) according to the instrument used: the conventional rigid ureteroscopes and the new fiberoptic small size ureteroscopes. From July 1985 to December 1992, we performed 248 URS in 238 patients using a conventional rigid ureteroscope. From January 1992 to December 1992, we performed 49 URS in 47 patients using a semirigid ureteroscope. The failure rate was 14.5% in the first group of patients. The early and late complications observed were: urinary tract infections (UTI) in 22.5%, small mucosal lesions (false route) in 24.5%, full-thickness perforations in 11.2%, migration of the stone fragments into the retroperitoneum in 0.4% and the rupture of the tip of an alligator forceps into the ureteral lumen in 0.4%. Ureteral stenosis was observed in 1.6% of the cases. Often two or more complications occurred in the same patient. In the second group the failure rate was 10.2% and the complication rate 8.1%. We reported one case of ureteral perforation (2%), 3 mucosal lesions (6.1%) and UTI in 2 cases (4%). We conclude that URS using a small-caliber semirigid ureteroscope is a safer procedure than URS with conventional instruments. The majority of failures with semirigid scopes is related to the laser ineffectiveness in fragmenting the stone.European Urology 02/1995; 28(2):112-5. · 10.48 Impact Factor
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ABSTRACT: Logistic regression yields an adjusted odds ratio that approximates the adjusted relative risk when disease incidence is rare (<10%), while adjusting for potential confounders. For more common outcomes, the odds ratio always overstates the relative risk, sometimes dramatically. The purpose of this paper is to discuss the incorrect application of a proposed method to estimate an adjusted relative risk from an adjusted odds ratio, which has quickly gained popularity in medical and public health research, and to describe alternative statistical methods for estimating an adjusted relative risk when the outcome is common. Hypothetical data are used to illustrate statistical methods with readily accessible computer software.American Journal of Epidemiology 05/2003; 157(10):940-3. · 4.78 Impact Factor
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ABSTRACT: We compared our experience with ureteroscopic stone basket manipulation under fluoroscopic guidance to ultrasound ureterolithotripsy for distal ureteral stone removal. Retrospectively, we analyzed the medical records of 981 patients with ureteral calculi between January 1994 and December 1995, of whom 483 (49%) were treated for stones in the lower ureter and constituted our study group. The decision of when to perform lithotripsy (group 2) versus a basket procedure (group 1) was based on a prospective nonrandomized study and both groups were compared historically. All 322 patients in group 1 (mean age 49 years, range 14 to 86) primarily underwent ureteroscopic stone basket manipulation using the 4-wire Segura* basket. If the calculus could not be removed with the basket and another procedure was necessary, the case was considered a failure. The 161 patients in group 2 (mean age 37 years, range 14 to 74) underwent initially ultrasound ureterolithotripsy for stone fragmentation followed or not by removal of the fragments with the basket. Stone size did not differ significantly between groups 1 (mean 0.9 cm., range 0.6 to 1.7) and 2 (mean 0.8 cm., range 0.7 to 2.0). Ureteroscopy was performed in both groups with epidural anesthesia and on an outpatient basis in the majority of cases. The stone-free rate after 1 procedure was 98.1 and 95.6% in group 1 and 2, respectively. For group 2 versus group 1 the operative time was longer (mean 50, range 25 to 90 versus mean 19 minutes, range 11 to 40, respectively, p < 0.001), the complication rate was greater (16.1 versus 4.3%, respectively, p < 0.001) and average hospital stay was longer (2.1 versus 0.15 day, respectively, p < 0.001). Ureteroscopic stone treatment with basket manipulation under fluoroscopic guidance or ultrasound ureterolithotripsy provided a high stone-free rate. However, stone removal with the basket manipulation technique should be considered the first choice for treatment of small distal ureteral calculi based on the minimal morbidity, and short operative and recovery times.The Journal of Urology 07/1997; 157(6):2081-3. · 3.70 Impact Factor