Concomitant treatment of ureteral calculi and ipsilateral pelvic sciatic nerve schwannoma with transperitoneal laparoscopic approach: A case report

BACKGROUND Schwannomas are rare peripheral neural myelin sheath tumors that originate from Schwann cells.Of the different types of schwannomas,pelvic sciatic nerve schwannoma is extremely rare.Definite preoperative diagnosis of pelvic schwannomas is difficult,and surgical resection is the gold standard for its definite diagnosis and treatment.CASE SUMMARY We present a case of pelvic schwannoma arising from the sciatic nerve that was detected in a 40-year-old man who underwent computed tomography for intermittent right lower back pain caused exclusively by a right ureteral calculus.Subsequently,successful transperitoneal laparoscopic surgery was performed for the intact removal of the stone and en bloc resection of the schwannoma.The total operative time was 125 min,and the estimated blood loss was inconspicuous.The surgical procedure was uneventful.The patient was discharged on postoperative day 5 with the simultaneous removal of the urinary catheter.However,the patient presented with motor and sensory disorders of the right lower limb,caused by partial damage to the right sciatic nerve.No tumor recurrence was observed at the postoperative appointment.CONCLUSION Histopathological examination of the specimen confirmed the diagnosis of a schwannoma.Thus,laparoscopic surgery is safe and feasible for concomitant extirpation of pelvic schwannomas and other pelvic and abdominal diseases that require surgical treatment.

Extracorporeal shock-wave versus pneumatic ureteroscopic lithotripsy in treatment of lower ureteral calculi

Aim: To compare the efficacy and complications of extracorporeal shock-wave lithotripsy (SWL) and pneumatic ureteroscopic lithotripsy (URS) in the treatment of lower ureteral calculi. Methods: From August 1997 to June 1999, 210 patients with calculi in the distal third of the ureter were treated with SWL and the other 180 with URS. The stones were fragmented with either HB-ESWL-V lithotripter or JML-93 pneumatic lithotripter through Wolf 7.5～9.0 Fr ureteroscope. The outcome was assessed in terms of stone clearance rate, re-treatment rate and complication incidence. Results: The stone clearance rate was 78.1% with SWL and 93.3 % with URS (P<0.05). SWL had a re-treatment rate of 11.9 %, vs 2.2 % in the URS group (P<.05). URS caused ureteral perforation in 3.3% of patients, while it was 0 with SWL (P<0.05). The differences in the incidence of other complications such as infection and stricture between the two groups were insignificant. Conclusion: Though the selection of these two options depends on equipments available and the expertise of the operator, we recommend URS as the optimal treatment for distal ureteral calculi. (Asian J Andro12002 Dec, 4: 303-305)

Role of Removing Stasis and Reducing Heat Formula in Clearance of Proximal Ureteral Calculi after Ureteroscopic Ho:YAG Laser Lithotripsy: A Prospective Randomized Study

Objective To prospectively evaluate the efficacy of Removing Stasis and Reducing Heat Formula in accelerating calculus clearance and improving lower urinary tract symptoms of patients with proximal ureteral calculi after ureteroscopic Ho:YAG laser lithotripsy. Methods A total of 138 patients with proximal ureteral calculi underwent ureteroscopic Ho:YAG laser lithotripsy by a single endocrinologist. Stone size varied from 10 to 15 mm. After operation, the patients were randomly divided into three groups: the control group(group A), tamsulosin group(group B), and Removing Stasis and Reducing Heat Formula group(group C). The treatment lasted for 4 weeks or until stone clearance. The primary and secondary outcomes of the three groups at follow-up were assessed. Results Of the 131 patients available for follow-up, 44 cases were in the group A, 45 in the group B, and 42 in the group C, respectively. The stone free rate at 2 weeks in the groups B and C were significantly higher than that in the group A(95.56%, 97.62% vs. 79.55%; all P<0.05). The ureteral colic rate and mean time of fragment expulsion were significantly reduced in the groups B(4.44% and 7.86±4.99 days) and C(2.43% and 6.76±4.37 days) compared with the group A(22.73% and 11.54±9.89 days, all P<0.05). On the day of double-J ureteric stent removal, the group C differed significantly from the group A in the total International Prostate Symptom Score, irritative subscore, obstructive subscore, and quality of life score(all P<0.05). Conclusion Removing Stasis and Reducing Heat Formula in the medical expulsive therapy might be an effective modality for patients with calculus in the proximal uretera after ureteroscopic Ho:YAG laser lithotripsy.

Ureteroscopic Holmium:YAG Laser Lithotripsy for Managing Ureteral Calculi (A Report of 168 Cases)

Summary: The effectiveness and safety of ureteroscopic holmium:YAG laser lithotripsy for managing ureteral calculi was evaluated. Ureteroscopic holmium:YAG laser lithotripsy was performed in 168 ureteral calculi (upper 27 cases, middle 33 cases and lower 108 cases). The results showed that the stone-free rate was 92.6 % in the upper ureteral calculi, 93.9 % in the middle ureteral calculi and 94.4 % in the lower ureteral calculi, respectively. The complication rate was 4.8 % (8 cases). It was suggested that ureteroscopic holmium:YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.

Changes of serum β2-MG, Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance

Objective:To investigate the changes of serumβ2 microglobulin(β2-MG),cystatin C(CysC)and urine microalbumin(mAlb)levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance.Methods Sixty-eight patients with ureteral calculi admitted to the hospital between June 2018 and June 2019 were selected as the observation group.35 volunteers who received physical elimination in the hospital during the same period were selected as the control group.Levels ofβ2-MG,Cys C and urine mAlb in the observation group were compared before and after treatment,and compared with those in the control group.Changes in serumβ2-MG,Cys C and urine mAlb levels and renal function indicators[blood urea nitrogen(BUN),serum creatinine(SCr)]in patients with different prognosis in the observation group after treatment were analyzed.The value of serumβ2-MG,Cys C and urine mAlb levels in the diagnosis and treatment of ureteral calculi was analyzed with ROC curve.The correlations between serumβ2-MG,Cys C and urine mAlb levels and renal function indexes were analyzed.Results Serumβ2-MG,Cys C and urine mAlb levels in the observation group before treatment were significantly higher than those in the same group after treatment or those in the control group(P<0.05).Serumβ2-MG,Cys C and urine mAlb levels,BUN and SCr in patients with residual stones were significantly higher than those in patients without(P<0.05).ROC curve analysis showed that the sensitivity and the area under the curve of combined detection of serumβ2-MG,Cys C and urine mAlb levels for evaluating the curative effect of extracorporeal shock wave lithotripsy on ureteral calculi were significantly higher/larger than those of single detection of the three(P<0.05).Partial correlation analysis showed that serumβ2-MG,Cys C and urine mAlb levels were positively correlated with BUN and SCr(P<0.05).Conclusion There are obvious changes of serumβ2-MG,Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy.The combined detection of the three indexes is helpful for the early diagnosis of ureteral calculi and the evaluation of renal function after lithotripsy.They can provide reference for protecting renal function in patients with ureteral calculi treated by extracorporeal shock wave lithotripsy.

Evaluation of Extracorporeal Shockwave Lithotripsy in the Management of Renal and Ureteral Calculi

Aim: To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. Materials and Methods: This is a retrospective study carried out over six years, between January 2014 and December 2020. All the patients were treated using a Direx Integra lithotripter, with the number of shockwaves ranging from 1200 to 3500, without anaesthesia and were discharged a few hours after the procedure on the same day. In a majority (63.75%) of the cases, the calculi were incidental findings. A Double-J stent was indicated in two patients and preceded extracorporeal lithotripsy because of renal colic and signs of urinary tract infection. Results: We recruited a total of 122 patients with a mean age of 42.19 ± 13.08. We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm. The failure rate was 13.9%, with 17 patients still having more than three fragments measuring more than 4 mm after 4 ESWL sessions. 1 (0.8%) had septic shock as a post ESWL complication while 6 (4.9%) benefitted from a complimentary medical and/or surgical treatment (double J stent placement). Conclusion: The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be particularly effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm. Extracorporeal lithotripsy, which can be performed on an outpatient basis (and without anaesthesia) is associated with minimal complications, and remains the option of choice for most upper urinary tract calculi.

Effectiveness of Medical Management in Spontaneous Expulsion of Lower Ureteral Calculi: A Prospective Study

Purpose: We evaluated the efficacy of combined drug therapy with alpha1-adrenergic antagonist tamsulosin and corticosteroid deflazocort for conservative expulsive therapy in patients with lower ureteric calculi. Materials and Methods: A total of 100 consecutive symptomatic patients with stones located in the Lower ureter were selected for the study who received oral tamsulosin 0.4 mg daily for 4 weeks and deflazocort 30 mg daily for 10 days and diclofenac IM/Oral on demand. Ultrasound follow-up and medical visits and X ray KUB were performed weekly for 4 weeks. Stone passage rate and time, pain episodes and endoscopical intervention were evaluated. Results: The stone expulsion rate was 87.8%. Mean stone size was 6.5 ± 2.14 mm. Mean expulsion time was 8 ± 1.84 days. Mean pain episodes were 1.50 ± 0.87 days. 11 patients needed intervention for stone retrieval. There was no statistically significant difference between the expulsion rates of right and left ureteral stones (P value = 0.31). Conclusions: Medical therapy with a combination of α1 adrenergic blocker and corticosteroid achieve good stone expulsion rates, lower pain episodes and should be considered in all patients with lower ureteral stones of size less than 10 mm who are not having any contraindications for medical therapy.

Clinical application of flexible ureteroscopic sheath with controllable intraluminal pressure in treating ureteral stones

Objective:The purpose of the study was to assess the clinical efficacy and safety of a combined perfusion suction platform with pressure feedback control function and an ureteroscopic suction sheath that can measure the ureteropelvic pressure in implementing lithotripsies.Methods:Fifty-two patients who underwent lithotripsy under intelligent monitoring of ureteral intraluminal pressure from June 2016 to January 2018 were retrospectively recruited.The inclusion standard was stone diameter>1.5 cm but<2.5 cm.After the 12/14 Fr suction sheath was placed,manometer interface and suction interface of the sheath were connected to the platform via the pressure sensor and suction tube,respectively.The ureteroscope was connected to the platform perfusion pump,and the crushed stones were aspirated out under negative pressure.Results:According to the location of the stone,21(40.4%)cases were classified as upper ureteral stones,19(36.5%)were midureteral stones,and 12(23.1%)were lower ureteral stones.Forty-seven patients underwent successful primary sheath placement and lithotripsy with a mean operative time of 34.5(standard deviation 18.3)min.Retrograde stone migration did not occur.There were eight patients with hematuria postoperatively.Serious complication was 1.9% with one case of ureteral perforation.Stone clearance was 95.7% at Day 1e2 postoperatively,and 100% at Day 30 postoperatively.Conclusion:Ureteroscopic lithotripsy with intelligent pressure control using our device improved the efficiency of the lithotripsy and rate of stone clearance.The safety of the operation can be ensured.It is worth popularization and application in clinical practice.

Transperitoneal Laparoscopic Ureterotomy: A Mini-Invasive Option for Ureteral Stones

Background and Objective: Laparoscopy can be an alternative modality in the management of ureteral stones. We herein present our experience with laparoscopic ureterolithotomy although most ureteral stones are managed using endourologic techniques, open surgery, or shockwave lithotripsy. Materials and Methods: This retrospective study was performed from January 2014 to December 2019 on 20 patients with ureteral stones who were treated using transperitoneal laparoscopic access. We collected data on patients’ ages, genders, clinical profiles, relevant medical history, sizes of the calculi, localisation of the calculi as confirmed by imaging, and outcome of lithotripsy. Continuous data were presented as mean values and standard deviations (for normally distributed data) and medians with interquartile ranges (for skewed data). Categorical data were presented as frequencies and percentages. Results: We included 20 patients (13 males and 7 females) with a mean age of 40.40 ± 13.25 years. The mean stone size was 18.5 ± 3.05 mm and all procedures were completed laparoscopically. The mean operative time was 96 ± 22.34 minutes. The mean estimated blood loss was less than 150 ml, and none of the patients received a blood transfusion. There was no intraoperative complication or postoperative complications, except for leakage of urine in the suture area. The mean hospital stay was 2.05 ± 0.69 days and the double J stent was removed after an average of 20 days post-operatively. The stone-free rate was 100% and after a mean follow-up period of 3 months, there was no stone recurrence. Conclusion: Laparoscopic ureterolithotomy is an effective and safe technique in the management of ureteric stones. The benefits of this technique include minimal postoperative morbidity, short postoperative hospitalization, a short convalescence period, and remarkable cosmetic results.

Electro-acupuncture Treatment for the Upper Segment Ureterolithiasis Under B-Ultrasonography

In order to explore the effects of the local strong stimulation generated by electro-acupuncture for treatment of the upper segment ureterolithiasis,a controlled study was carded out among the treatment group (electro-acupuncture with strong stimulation),the control group Ⅰ(medication) and the control group Ⅱ (conventional acupuncture).The results showed that the differences in the cure rate and the total effective rate between the treatment group and the two control groups were significant in statistical analysis (P<0.05 and P<0.01 respectively).This indicates that better therapeutic effects can be obtained by the local strong stimulation generated by electro-acupuncture for treatment of the upper segment ureterolithiasis.

Point Injection for Treating Nephritic Colic

Since 1994, the authors have treated 101 cases of nephritic colic by point injection therapy and achieved good curative results. Of them, 70 cases were diagnosed as having renal or ureteral calculi confirmed by abdominal X-ray and B-ultrasonic examination; and the others had the following symptoms: 1) sudden onset; 2) angina in unilateral lumbar and abdominal regions; 3) percussion-induced pain in the ipsilateral kidney region; and 4) erythrocytes or visible blood in urine found by laboratory test.

Tamsulosin as medical expulsive therapy for lower ureterolithiasis:A meta-analysis

Objective: To review the evidence for tamsulosin as medical expulsive therapy in enhancing the effectiveness of distal ureteral stone clearance rate. Methods: We searched Pubmed/Medline, Embase, CBM and the Cochrane Library up to October 2011. All randomized controlled trials in which tamsulosin was evaluated with distal ureterolithiasis were eligible for the analysis. Outcome measure assessed was stone clearance rate. Two authors independently assessed study quality and extracted data. All data were analyzed using RevMan 5.1. Results: Thirteen studies involving 1067 participants met the inclusion criteria. Study duration ranged from 7 to 42 d. The pooled analysis showed an improvement of 41% in stone clearance rate of tamsulosin as medical expulsive therapy for distal ureteral calculi (RR=1.41, 95% CI=1.18 to 1.70). According to stone size (6 mm<size<10 mm, 5 mm<size<6 mm, size <5 mm), the pooling effects of tamsulosin were analyzed, with a higher stone expulsion rate obtained than control (RR=1.52, 1.75, 1.05, 95% CI=1.30 to 1.77, 1.25 to 2.45, 0.95 to 1.16, respectively). Adverse effects of tamsulosin, mainly retrograde ejaculation, dizziness and hypotension, were reported in 7 included trials. Conclusion: Treatment with tamsulosin appears to be a safe and effective medical expulsion therapy for distal ureterolithiasis. To make a definite clinical recommendation to use tamsulosin as medical expulsive treatment for distal ureteral calculi, high quality multicentric, randomized, double blinded, controlled trials are necessary to prove its efficacy.

Spontaneous distal ureteric rupture: A rare case report and review of literature

Spontaneous rupture of the ureter is a very interesting and unusual phenomenon which normally occurs due to ureteral obstruction.We present a case of spontaneous rupture of the distal ureter,secondary to a ureteric calculus.Our patient presented with a history of acute on chronic abdominal pain and was septic on arrival to hospital.

Comparison of mini-percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy for treatment of impacted proximal ureteral stones greater than 15 mm

Background:The optimal treatment for large impacted proximal ureteral stones remains controversial.The aim of this study was to evaluate the efficacy,safety,and potential complications of mini-percutaneous nephrolithotomy(MPCNL)and retroperitoneal laparoscopic ureterolithotomy(RPLU)in the treatment of impacted proximal ureteral stones with size greater than 15 mm.Methods:A total of 268 patients with impacted proximal ureteral stones greater than 15 mm who received MPCNL or RPLU procedures were enrolled consecutively between January 2014 and January 2019.Data on surgical outcomes and complications were collected and analyzed.Results:Demographic and ureteral stone characteristics found between these two groups were not significantly different.The surgical success rate(139/142,97.9%vs.121/126,96.0%,P=0.595)and stone-free rate after 1 month(139/142,97.9%vs.119/126,94.4%,P=0.245)of RPLU group were marginally higher than that of the MPCNL group,but there was no significant difference.There was no significant difference in the drop of hemoglobin between the two groups(0.8±0.6 vs.0.4±0.2 g/dL,P=0.621).The mean operative time(68.2±12.5 vs.87.2±16.8 min,P=0.041),post-operative analgesics usage(2/121,1.7%vs.13/139,9.4%,P=0.017),length of hospital stay after surgery(2.2±0.6 vs.4.8±0.9 days,P<0.001),double J stent time(3.2±0.5 vs.3.9±0.8 days,P=0.027),time of catheterization(1.1±0.3 vs.3.5±0.5 days,P<0.001),and time of drainage tube(2.3±0.3 vs.4.6±0.6 days,P<0.001)of MPCNL group were significantly shorter than that of the RPLU group.The complication rate was similar between the two groups(20/121,16.5%vs.31/139,22.3%,P=0.242).Conclusions:MPCNL and RPLU have similar surgical success and stone clearance in treating impacted proximal ureteral stones greater than 15 mm,while patients undergoing MPCNL had a lower post-operative pain rate and a faster recovery.

Treatment of lower urethral calculi with extracorporeal shock-wave lithotripsy and pneumatic ureteroscopic lithotripsy: a comparison of effectiveness and complications

Objective To determine the efficacy and incidence of complications of extracorporeal shock wave lithotripsy (ESWL) compared with pneumatic ureteroscopic lithotripsy (URSL) in the treatment of lower uretheral calculi Methods From August 1997 to June 1999, 210 patients with lower ureteric calculi were treated with ESWL and the other 180 with URSL The stones were fragmented with pneumatic lithotripter The outcome was assessed by evacuation, retreatment and complication rates Results ESWL for lower ureteric calculi resulted in a stone evacuation rate of 78 1%, compared with 93 3% for URSL ( P <0 05) ESWL had a retreatment rate of 11 9% and a perforation rate of 0, while URSL caused perforation of ureters in 3 3% of patients and a refreatment of 2.2% Conclusion For the management of lower ureteric calculi, ESWL provides a non invasive, simple and safe option, and URSL has a higher stone evacuation rate but causes ureter perforation more frequently than ESWL does Both ESWL and URSL have their respective advantages It is recommended, however, that URSL be extensively developed for better treatment efficacy, given that the operator has an adequate technical background

When should we give up on expectant management for patients with proximal ureteral stones?

Background:Proximal ureteral stones(PUS)have relatively low rates of spontaneous expulsion.However,some patients do on expectant management.Our aim was to compare risk factors for surgical intervention in patients with PUS who underwent primary intervention to those subjected to expectant management.Materials and methods:We retrospectively reviewed the medical charts of patients presented to the emergency room with symptoms of renal colic and underwent computerized tomography between August 2016 and August 2017.A total of 97 consecutive patients were identified with up to 10 mm PUS.We collected patient demographics,clinical,and imaging data,and performed binary regression analysis for risk of intervention.Results:The average age was 49years(range 17-97)and average stone size was 7.1 mm(range 3-10).Forty-one patients underwent immediate intervention while the remaining 56 patients were treated conservatively.Of the 56 patients treated conservatively,26 underwent delayed intervention while 30 reported spontaneous stone expulsion.On univariate analysis of all 97 patients,statistically significant risk factors for intervention were found based on stone size,age,serum lymphocyte,platelet counts,and stone density.Of these risk factors,stone size≥7mm(p=0.012,odds ratio=5.4)and platelet count?230K/mL(p=0.027,odds ratio=4.9)remained statistically significant on multivariate analysis.Conclusion:Stone size and platelet count were found to be risk factors for surgical intervention in patients with up to 10 mm PUS.These findings may assist in identifying patients who are more suitable for conservative approach.

Which objective emergency department parameters leads to expedited intervention in patients with acute urinary tract calculi

Objectives:To retrospectively determine which objective measurements had an increased likelihood of requiring immediate surgical intervention in patients presenting to the emergency department(ED)with acute ureteral calculi.Materials and methods:Employing our institution's electronic medical record system,we conducted a retrospective cohort study of 4366 patients who presented to the ED with an acute ureteral calculus over an 8-year period.Data consisting of relevant demographic information,vital signs,laboratory parameters,and interventional history was obtained and analyzed.Results:This study consisted of 4366 patients presenting to the ED with acute ureteral calculi,of whom 312(7%)required a procedure prior to being discharged.Of these 312 patients,290(6.6%)underwent cystoscopy with ureteral stent placement and 22(0.5%)were sent to interventional radiology for percutaneous nephrostomy tube placement.Patients who tested positive for nitrites in their urine had a relative risk of 3.48 of receiving intervention when compared to the nitrite negative group.Conclusions:Through this retrospective cohort study,we were able to find what objective measurements were associated with an increased need for immediate surgical intervention in patients who presented to the ED with acute ureteral calculi.With this data,urologists can be better equipped to identify the patients that present in the emergency setting that will require urgent intervention.

Predicting urine culture results in candidates for lithotripsy

Background:Urological guidelines assert that"urine culture should be obtained"before surgical management of ureteral or kidney stones.Thus,many surgeries are delayed by 1-3 days until the results of urine culture are available.During this time,the patient frequently experience pain and possible kidney damage.We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission.Materials and methods:A database of 1000 patients who underwent either percutaneous nephrolithotomy(PCNL)or ureteroscopy/retrograde intrarenal surgery was analyzed.Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results.Results:Of the patients,234(23.4%)had positive cultures.On multivariate analysis,only sex,hydronephrosis grade,and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture.The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator.This risk could be as low as 0.45%for a man without a history of PCNL and no hydronephrosis(4%in a woman with similar parameters)or as high as 79.5%in a man with a history of PCNL and hydronephrosis(85%in a woman with similar parameters).Conclusions:The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission.In low-risk cases,prompt surgical treatment can be provided,eliminating the anticipation time for urine culture results.