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JAMA Internal Medicine Aug 2018Urinary stone disease is a common presentation in the emergency department, and α-adrenergic receptor blockers, such as tamsulosin, are commonly used to facilitate... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Urinary stone disease is a common presentation in the emergency department, and α-adrenergic receptor blockers, such as tamsulosin, are commonly used to facilitate stone passage.
OBJECTIVE
To determine if tamsulosin promotes the passage of urinary stones within 28 days among emergency department patients.
DESIGN, SETTING, AND PARTICIPANTS
We conducted a double-blind, placebo-controlled clinical trial from 2008 to 2009 (first phase) and then from 2012 to 2016 (second phase). Participants were followed for 90 days. The first phase was conducted at a single US emergency department; the second phase was conducted at 6 US emergency departments. Adult patients were eligible to participate if they presented with a symptomatic urinary stone in the ureter less than 9 mm in diameter, as demonstrated on computed tomography.
INTERVENTIONS
Participants were randomized to treatment with either tamsulosin, 0.4 mg, or matching placebo daily for 28 days.
MAIN OUTCOMES AND MEASURES
The primary outcome was stone passage based on visualization or capture by the study participant by day 28. Secondary outcomes included crossover to open-label tamsulosin, time to stone passage, return to work, use of analgesic medication, hospitalization, surgical intervention, and repeated emergency department visit for urinary stones.
RESULTS
The mean age of 512 participants randomized to tamsulosin or placebo was 40.6 years (range, 18-74 years), 139 (27.1%) were female, and 110 (22.8%) were nonwhite. The mean (SD) diameter of the urinary stones was 3.8 (1.4) mm. Four hundred ninety-seven patients were evaluated for the primary outcome. Stone passage rates were 50% in the tamsulosin group and 47% in the placebo group (relative risk, 1.05; 95.8% CI, 0.87-1.27; P = .60), a nonsignificant difference. None of the secondary outcomes were significantly different. All analyses were performed according to the intention-to-treat principle, although patients lost to follow-up before stone passage were excluded from the analysis of final outcome.
CONCLUSIONS AND RELEVANCE
Tamsulosin did not significantly increase the stone passage rate compared with placebo. Our findings do not support the use of tamsulosin for symptomatic urinary stones smaller than 9 mm. Guidelines for medical expulsive therapy for urinary stones may need to be revised.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT00382265.
Topics: Adolescent; Adrenergic alpha-1 Receptor Antagonists; Adult; Aged; Dose-Response Relationship, Drug; Double-Blind Method; Emergency Service, Hospital; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retrospective Studies; Tamsulosin; Tomography, X-Ray Computed; Treatment Outcome; Ureteral Calculi; Urination; Young Adult
PubMed: 29913020
DOI: 10.1001/jamainternmed.2018.2259 -
Basic & Clinical Pharmacology &... Jan 2022The primary goals of medical expulsive therapy are to increase the rate of stone expulsion along the ureter to avoid ureteral obstruction and reduce ureteral colic and... (Review)
Review
The primary goals of medical expulsive therapy are to increase the rate of stone expulsion along the ureter to avoid ureteral obstruction and reduce ureteral colic and thus avoid the need for surgical and more invasive interventions. This review focussed on the findings from in vivo and in vitro animal and human studies that have investigated the pharmacological mechanisms controlling ureteral motility and their translation to current and potentially new clinically used drugs for increasing the rate of stone expulsion along the ureter. The complicated contractility profile of the ureter, which alters with age, tissue segment region, orientation and species contributes to the difficulty of interpreting studies on ureteral pharmacology, which translates to the complexity of discovering ideal drug targets for medical expulsive therapy. Nevertheless, the current drug classes clinically used for patients with stone lodgement include α -adrenoceptor antagonists, calcium channel blockers and NSAIDS, whilst there are promising targets for drug development that require further clinical investigations including the phosphodiesterase type 5 enzyme, β-adrenoceptors and 5-HT receptors.
Topics: Age Factors; Animals; Drug Development; Drug Discovery; Humans; Species Specificity; Treatment Outcome; Ureter; Ureteral Calculi
PubMed: 33991399
DOI: 10.1111/bcpt.13613 -
Scientific Reports Jul 2020Difficulty in performing ureteroscopic lithotripsy (URSL) depends on endoscopic findings surrounding calculi. In this multicentre prospective cohort study of 185...
Difficulty in performing ureteroscopic lithotripsy (URSL) depends on endoscopic findings surrounding calculi. In this multicentre prospective cohort study of 185 patients with a single ureteral stone who underwent ureteroscopic lithotripsy registered in the SMART study between January 2014 and February 2017, we established a classification of endoscopic findings and analysed risk factors for ureteral changes. We evaluated endoscopic findings (oedema, polyps, ureteral mucosa-stone adherence, and distal ureteric tightness) based on the SMART classification. Operative time and ureteral injuries were significantly correlated with endoscopic finding grades. Multivariate analyses revealed that mucosa-stone adherence (MSA) was strongly affected by hydronephrosis grade (odds ratio, 12.4; p = 0.022) and the interval before surgery (odds ratio, 1.10; p = 0.012). The cutoff value for MSA was 98 days, with a predictive accuracy of 0.78. Risk factors for distal ureteric tightness were age (odds ratio, 0.96; p = 0.004) and early intervention (odds ratio, 0.90; p = 0.023). The cutoff value was 34 days, with a predictive accuracy of 0.72. In conclusion, appropriate intervention around 34 days (limited to 98 days) after symptom onset is necessary for treating ureteral calculi. Even if intervention passed 98 days post-symptom onset, staged URSL, alternative procedures, and detailed informed consent should be planned in advance, assuming strong MSA.
Topics: Adult; Aged; Comorbidity; Disease Management; Female; Humans; Incidence; Male; Middle Aged; Prospective Studies; ROC Curve; Risk Factors; Symptom Assessment; Ureteral Calculi; Ureteroscopy
PubMed: 32704036
DOI: 10.1038/s41598-020-69158-w -
Asian Journal of Surgery Aug 2023
Topics: Humans; Ureteral Calculi; Ureteroscopy; Lithotripsy; Treatment Outcome
PubMed: 36990819
DOI: 10.1016/j.asjsur.2023.03.078 -
Annals of Medicine Dec 2023Patients with ureteral calculi and systemic inflammatory response syndrome (SIRS) often require emergency drainage, and percutaneous nephrostomy (PCN) and retrograde... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
Patients with ureteral calculi and systemic inflammatory response syndrome (SIRS) often require emergency drainage, and percutaneous nephrostomy (PCN) and retrograde ureteral stent insertion (RUSI) are the most commonly used methods. Our study aimed to identify the best choice (PCN or RUSI) for these patients and to examine the risk factors for progression to urosepsis after decompression.
METHODS
A prospective, randomized clinical study was performed at our hospital from March 2017 to March 2022. Patients with ureteral stones and SIRS were enrolled and randomized to the PCN or RUSI group. Demographic information, clinical features and examination results were collected.
RESULTS
Patients ( = 150) with ureteral stones and SIRS were enrolled into our study, with 78 (52%) patients in the PCN group and 72 (48%) patients in the RUSI group. Demographic information was not significantly different between the groups. The final treatment of calculi was significantly different between the two groups ( < .001). After emergency decompression, urosepsis developed in 28 patients. Patients with urosepsis had a higher procalcitonin ( = .012) and blood culture positivity rate ( < .001) and more pyogenic fluids during primary drainage ( < .001) than patients without urosepsis.
CONCLUSION
PCN and RUSI were effective methods of emergency decompression in patients with ureteral stone and SIRS. Patients with pyonephrosis and a higher PCT should be carefully treated to prevent the progression to urosepsis after decompression.Key messageIn this study, we evaluate the best choice (PCN or RUSI) for patients who have ureteral stones and SIRS and to examine the risk factors for progression to urosepsis after decompression. This study found that PCN and RUSI were effective methods of emergency decompression. Pyonephrosis and higher PCT were risk factors for patients to develop to urosepsis after decompression.
Topics: Humans; Decompression, Surgical; Nephrostomy, Percutaneous; Procalcitonin; Prospective Studies; Prosthesis Implantation; Pyonephrosis; Sepsis; Stents; Systemic Inflammatory Response Syndrome; Ureteral Calculi
PubMed: 36883206
DOI: 10.1080/07853890.2023.2169343 -
Medicine Sep 2019Ureteral calculi generally refer to the temporary obstruction of the human body after the ureteral stenosis. When the ureteral stones are not discharged in time, they...
BACKGROUND
Ureteral calculi generally refer to the temporary obstruction of the human body after the ureteral stenosis. When the ureteral stones are not discharged in time, they can grow in the original site, causing the patient to have corresponding clinical manifestations, such as: renal colic, hematuria, etc, when severe, can cause renal obstruction and hydronephrosis, seriously endangering the patient's health. Ureteral calculi usually occur in young and middle-aged people. The peak age of the disease is between 20 and 50 years old. It also occurs in the young and middle-aged labor force. The men incidence rate is 2 to 3 times that of women. Ureteral calculi is one of the current refractory diseases, and the effect after treatment with integrated Chinese and Western medicine is remarkable.
METHODS AND ANALYSIS
We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2018. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of ureteral.
ETHICS AND DISSEMINATION
This systematic review will evaluate the efficacy and safety of Traditional Chinese medicine for ureteral. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process Trial.Registration number: PROSPERO CRD42019137095.
Topics: Humans; Medicine, Chinese Traditional; Meta-Analysis as Topic; Systematic Reviews as Topic; Ureteral Calculi
PubMed: 31517825
DOI: 10.1097/MD.0000000000017057 -
Scientific Reports Feb 2020In this study, the term "ultrasonic ureteral crossing sign" is defined, and the diagnostic accuracy of this sign in the rapid localization of ureteral calculi is...
In this study, the term "ultrasonic ureteral crossing sign" is defined, and the diagnostic accuracy of this sign in the rapid localization of ureteral calculi is assessed. Between January 2017 and June 2018, 535 patients underwent ultrasound examination for suspected ureteral calculi. The "ultrasonic ureteral crossing sign" was classified as either positive or negative and correlated with the location of ureteral calculi. Of the 451 patients who were ultimately diagnosed with ureteral calculi, 263 patients had a positive sign, of which 258 patients had distal ureteral calculi, and 188 patients had a negative sign, of which 164 patients had proximal ureteral calculi. Eighteen stones were located in the ureter across the iliac vessels. For patients with a positive "ultrasonic ureteral crossing sign", we observed a 91% sensitivity, 97% specificity, 98% PPV, 87% NPV, and AUC of 0.94 for distal ureteral calculi. For patients with a negative "ultrasonic ureteral crossing sign", we observed a 97% sensitivity, 91% specificity, 87% PPV, 98% NPV, and AUC of 0.94 for proximal ureteral calculi. The "ultrasonic ureteral crossing sign" was found to accurately predict the location of ureteral calculi, significantly improve the efficiency of ultrasound examination, and provide a useful basis for follow-up treatment.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Predictive Value of Tests; ROC Curve; Renal Colic; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography; Ureter; Ureteral Calculi; Young Adult
PubMed: 32024890
DOI: 10.1038/s41598-020-58805-x -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Oct 2023This paper analyzed the clinical data, diagnosis and treatment of 4 asymptomatic patients with ureteral calculi without hydrops in our hospital from October 2018 to...
This paper analyzed the clinical data, diagnosis and treatment of 4 asymptomatic patients with ureteral calculi without hydrops in our hospital from October 2018 to January 2019, and comprehensively discussed the previous literature. The 4 patients in this group had no obvious clinical symptoms, no positive stones were found in the B-ultrasound of the urinary system, and no hydroureter and hydroureter of the affected side was found. Urinary CT scan confirmed ureteral stones. They were all located in the lower ureter, and the stones obstructed the lumen. The stones were round and smooth, and there was no obvious hyperplasia and edema in the surrounding mucosa. The lithotripsy was completed in the first-stage operation, and the DJ catheter was left behind for one month after the operation. Based on the clinical diagnosis and treatment process of the 4 cases of asymptomatic calculi in this group and the analysis of previous studies, these patients were mostly detected by imaging examinations or other systematic imaging examinations during the regular review of urinary calculi. Ureteral stones with obstruction did not necessarily have stone-related symptoms. The onset of renal colic involved an increase in intraluminal pressure, related stimulation of nerve endings, smooth muscle spasms caused by stretching of the ureteral wall, and systemic changes in cytokines and related hormones. Cascade reactions, etc., were associated with the movement of stones down. Ureteral stones without hydrops were mostly located in the lower ureter, which had a certain buffering effect on obstructive pressure. Asymptomatic ureteral calculi could also induce irreversible damage to renal function, and the proportion of damage increased with the diameter of the stone. Patients with a history of urinary calculi, especially those with asymptomatic stones for the first time, should be paid attention to during clinical follow-up. At present, there are few research reports on asymptomatic and non-accumulating ureteral calculi. We analyze the clinical diagnosis and treatment process and characteristics of this group of patients combined with previous literature to provide a reference for the diagnosis and treatment of such patients.
Topics: Humans; Ureteral Calculi; Urinary Calculi; Ureter; Lithotripsy; Edema; Kidney Calculi
PubMed: 37807752
DOI: 10.19723/j.issn.1671-167X.2023.05.025 -
The Journal of Urology Aug 2012We evaluated the cost-effectiveness of ureteral/renal stone treatment by comparing ureteroscopy, extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. (Comparative Study)
Comparative Study Review
PURPOSE
We evaluated the cost-effectiveness of ureteral/renal stone treatment by comparing ureteroscopy, extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy.
MATERIALS AND METHODS
We performed a systematic literature search to identify studies of treatment for adults with ureteral and renal stones that were published between 1995 and 2010. For inclusion in analysis studies had to provide the stone-free rate and the cost of at least 2 therapies.
RESULTS
Ten studies were identified, including 8 with an observational design and 2 that synthesized data using decision modeling techniques. Five of 6 studies, including 1 of 2 from the United States, compared ureteroscopy vs shock wave lithotripsy for proximal stones and showed a higher stone-free rate and lower cost for ureteroscopy. Four of the 5 studies, including the only American study, compared ureteroscopy vs shock wave lithotripsy for distal ureteral stones and also showed such an economically dominant result. Studies of shock wave lithotripsy vs percutaneous nephrolithotomy and ureteroscopy vs percutaneous nephrolithotomy for renal stones demonstrated higher cost and a higher stone-free rate for percutaneous nephrolithotomy.
CONCLUSIONS
Despite the great heterogeneity and limited quality of available cost-effectiveness evaluations most studies demonstrated that ureteroscopy was more favorable than shock wave lithotripsy for ureteral stones in stone-free rate and cost.
Topics: Cost-Benefit Analysis; Female; Follow-Up Studies; Humans; Kidney Calculi; Lithotripsy; Male; Nephrostomy, Percutaneous; Recurrence; United States; Ureteral Calculi; Ureteroscopy
PubMed: 22698623
DOI: 10.1016/j.juro.2012.04.008 -
Urologia Internationalis 2016We aimed at evaluating the efficacy of extracorporeal shockwave lithotripsy (SWL) for treating distal ureteral calculi performed in supine vs. prone position. (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
We aimed at evaluating the efficacy of extracorporeal shockwave lithotripsy (SWL) for treating distal ureteral calculi performed in supine vs. prone position.
MATERIALS AND METHODS
Eligible studies were identified by 2 reviewers using PubMed, Embase, and Web of Science databases. Outcomes included stone-free rate after the first and the final SWL session, the mean number of shocks per SWL session, the mean percentage of power used in the first SWL session, and the mean number of SWL sessions per patient.
RESULTS
Pooled data among the 647 included patients showed that supine SWL was associated with a significantly higher stone-free rate than prone SWL. This difference was consistent for both the first SWL session (OR 4.17; 95% CI 2.53-6.87; p < 0.00001) and the final session (OR 3.02; 95% CI 1.96-4.67; p < 0.00001). No differences in the mean number of shocks per SWL session, the mean percentage of power used in the first SWL session, and the mean number of SWL sessions per patient were observed between the positions. SWL complications were infrequent and the incidence was insufficient for further analysis.
CONCLUSION
SWL is safe and effective for the management of distal ureteral calculi, and supine SWL is more effective than prone SWL for achieving a stone-free status.
Topics: Humans; Lithotripsy; Patient Positioning; Prone Position; Supine Position; Ureteral Calculi
PubMed: 26352560
DOI: 10.1159/000439140