Effect of tamsulosin versus tamsulosin plus tadalafil on renal calculus clearance after shock wave lithotripsy:An open-labelled,randomised,prospective study

Objectives:To compare the efficacy of tamsulosin versus tamsulosin plus tadalafil in achieving clearance of fragments after shock wave lithotripsy(SWL)to treat renal calculi.Methods:Between January 2016 to December 2017,140 patients with solitary,non-branched,non-lower calyceal renal calculus and measuring less than 20 mm and treated with SWL were randomized to tamsulosin(group A)or tamsulosin plus tadalafil(group B).Therapy was given for a period of 4 weeks.Stone clearance rate,analgesic requirement,occurrence of steinstrasse,need for auxiliary procedures(endoscopic treatment),and adverse effects of drugs were recorded.Results:The overall clearance rate was 72.5%(50/69)in the group A and 90.1%(64/71)in the group B(pZ0.007).For stones up to 12 mm,the difference in the clearance rate was significant(pZ0.039)while it was not so for stones larger than 12 mm(pZ0.151).There was no statistically significant difference between the two groups with regards to analgesic requirement(pZ0.94),occurrence of steinstrasse(pZ0.101),need for auxiliary procedures(pZ0.76),and adverse effects of the drugs(pZ0.148).Conclusion:Our study shows that adjunctive medical expulsive therapy with tamsulosin and tadalafil achieves better clearance rate than tadalafil alone in patients receiving SWL for renal stones.

Inadvertent insertion of nephrostomy tube into the renal vein following percutaneous nephrolithotomy: A case report and literature review

Percutaneous nephrolithotomy(PCNL)is an effective and well accepted procedure for the treatment of large and complex renal calculi.We encountered a patient with a mis-placed percutaneous nephrostomy drainage tube(PNDT)into the contralateral renal vein re-sulting thrombus formation after undergoing right side PCNL.We placed a temporary filter to prevent embolism and started anti-coagulation therapy immediately and finally the PNDT was removed without bleeding.

Ureteral calculi secondary to a gradually migrated acupuncture needle

We herein presented a case of calculi secondary to a migrated acupuncture needle.A 74-year-old woman with a history of acupuncture therapy for lumbago was referred to our hospital for treatment of ureteral and renal pelvic calculi.Abdominal multi-detector computed tomography scans showed ipsilateral hydronephrosis and two calculi secondary to a migrated acupuncture needle.First,a percutaneous nephrolithotomy was performed to extract two calculi and fine needle fragments from the pelvis.Subsequently,residual needle fragments and calculi in the ureter were then removed by flexible transurethral lithotripsy using a holmium laser.In the present case,the formation of the calculi was caused by a migrated acupuncture needle.Calculi and needle fragments were removed safely endoscopically because the whole calculi and needle fragments were located in the ureteral lumen.ª2021 Editorial Office of Asian Journal of Urology.Production and hosting by Elsevier B.V.This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Kidney inflammatory myofibroblastic tumor masquerading as metastatic malignancy: A case report and literature review

BACKGROUND Inflammatory myofibroblastic tumor(IMT) is a rare mesenchymal tumor that is characterized by spindle cells differentiated from muscle fibroblasts and infiltration of various types of inflammatory cells. IMT can occur at any age and at any anatomic site. The most common location of IMT is the bladder in the genitourinary tract. Only scarce cases of kidney IMT have been reported in the literature.CASE SUMMARY A 77-year-old woman, with a history of bilateral renal calculus for 15 years, was admitted to the Department of Urology of our hospital complaining of recurrent painless gross hematuria for one month. The treatment with cephalosporin was ineffective. Computed tomography imaging showed a mixed density and slightly heterogeneously enhanced lesion in the middle pole of the left kidney and ipsilateral adrenal enlargement. The patient underwent surgical treatment by retroperitoneoscopic left radical nephrectomy plus adrenalectomy. A large number of typical spindle cells surrounded by plasma cells and lymphocytes were observed microscopically. Immunohistochemical analyses indicated that these spindle cells were positive for vimentin, cytokeratin(CK), Ki-67, CK7,CD34, and CD31 and were focally positive for CD10 and anaplastic lymphoma kinase(ALK-1). Thus, a diagnosis of IMT was made definitively. The patient recovered well after operation, and no recurrence or metastasis was noted during the 22-mo follow-up.CONCLUSION Since kidney IMT is very rare and lacks characteristic clinical manifestation, it is easily misdiagnosed as a malignant tumor before operation. Surgery remains the best choice for diagnosis and treatment, and such cases must be followed carefully because of the uncertain biological behavior of this tumor. This report suggests that renal calculus may be one of the causes of IMT, but further investigation is necessary to prove it.

Unusual case of nephrocutaneous fistula--Our experience

A rare case of nephrococutaneous fistula due to spontaneous expulsion of renal calculi is described.A 45-year-old man presented with urinary leakage from an ulcer over the left lumbar region for the last 3 months after a history of spontaneous expulsion of stones from this area.Ultrasonography abdomen revealed a small contracted kidney with multiple calculi in the kidney and renal pelvis,sinus tract from the lower pole of the left kidney with a ruptured calyceal calculus in the sinus tract.CT urography revealed a non excreting left kidney with multiple renal calculi,with hyperdense collection in the renal parenchyma extending to the subcutaneous tissue and left lung suggesting a xenthogranulomatous pyelonephritis(XGP).We performed a left-sided simple nephrectomy with excision of the fistulous tract.Histopathological examination revealed XGP.There have been a few case reports of XGP forming nephrocutaneous fistula in the back.

肾、输尿管结石ESWL后开放手术23例临床分析

目的探讨肾、输尿管结石ESWL后开放手术的原因及手术时机。方法回顾性分析23例肾、输尿管结石ESWL后开放手术的原因、手术时机的选择及预后。结果23例患者ESWL治疗50次,平均2.2次。术中发现部分结石不同程度粉碎,部分被肾盂、输尿管黏膜增生的肉芽组织包裹,碎石后的肾、肾盂、输尿管周围组织不同程度粘连水肿。结论肾、输尿管结石在ESWL前应慎重评估,对于肾、输尿管结石病史较长、结石较大、并发肾积水,采用ESWL应慎重;对于ESWL超过2次且结石不能有效排出者,要考虑外科手术干预。