To evaluate the optimal duration of Medical Expulsive Therapy (MET) application for distal ureteric stones on a time period based manner. 89 patients with 5–10 mm distal ureter stones received tamsulosin (0.4 mg) for MET and diclofenac sodium (75 mg) for analgesia. Patients were evaluated once a week for 4 weeks. Radiologic stone passage was evaluated by kidney ureter bladder (KUB) and ultasonography where non-contrast computed tomography (NCCT) was also performed if needed. While 23 cases (28.4%) were SF after first week, 23 were SF (28.4%) after 2 weeks, 9 cases (11.1%) after 3 and lastly 7 cases (8.6%) became SF after four weeks. Nineteen (23.5%) cases were not SF after 4 weeks. A positive relationship was found between the time period elapsed for stone passage and ureteral wall thickness (UWT) along with the degree of hydronephrosis. In addition, mean number of renal colics and emergency department (ED) visits were found to be higher in patients passing stones in the 4th week along with the ones who could not despite MET. SFR for distal ureteric stones sizing 5–10 mm was higher within the first 3 weeks under MET application. Thus, waiting for a longer period of time may result in increased analgesic and unnecessary MET treatment with increased risk of emergency department visits and additional costs as well. We believe that other options could be considered in such cases who are not SF at the end of the first 3 weeks.

Sahin C, et al. Investig Clin Urol. 2023 Apr;64:e25. https://doi.org/10.4111/icu.20230011

To identify the radiological parameters which may help to predict the success of ureteral access sheath (UAS) placement during retrograde intrarenal surgery (RIRS).The study included 49 patients in whom failure ureteral access sheath placement in RIRS and 49 control group patients who were successfully placement between January 2023 and December 2023. The age, gender, body mass index (BMI), non-contrast computed tomography (NCCT), and kidney ureter bladder (KUB) radiographs were compared between the two groups. Measurements of the anteroposterior (ap) diameter of the pelvic inlet, anteroposterior diameter of the pelvic outlet, interspinous distance diameter were taken from non-contrast computed tomography (NCCT), while pelvic anteroposterior diameter and pelvic lateral diameter were measured from kidney ureter bladder (KUB) radiography. There were no significant differences between the groups in age, gender, body mass index, ap pelvic inlet diameter, ap pelvic outlet, and interspinous distance diameter. However, a statistically significant difference was found between the pelvic ap diameter and pelvic lateral diameter values measured on the KUB radiography. The values for pelvic ap diameter and pelvic lateral diameter measured in the KUB radiographs can be used to predict the likelihood of UAS passage during RIRC procedures. However, further studies with larger patient groups are needed to establish a cut-off value.

Aim: This study aimed to evaluate the potential impact of stone characteristics, patient factors, and upper tract anatomical parameters in the prediction of residual fragments (RFs) following the flexible ureteroscopic (fURS) management of renal stones. Patients and Methods: Between June 2023 and July 2024, a total of 104 cases underwent fURS for the minimally invasive management of medium-sized renal stones (10–25 mm), and 28 cases presenting with RFs 3 months after these procedures were included for further evaluation. In addition to the assessment of patient-related factors, non-contrast computed tomography (NCCT) was performed in all cases in an attempt to assess specific stone characteristics and upper tract anatomical parameters in detail during the 3-month follow-up period. Results: An evaluation of our findings indicated that, among the evaluated parameters, a higher degree of hydronephrosis (>Grade 2), a larger stone size (>15 mm), and the presence of multiple stones were found to affect the presence of RFs significantly (p = 0.020, p = 0.012, and p = 0.040, respectively). On the other hand, although the analysis of other parameters such as patient gender, stone side, stone hardness, and the use of an access sheath with univariate regression demonstrated potential correlations, none of these parameters demonstrated a significant impact when analyzed using backward logistic regression. Logistic regression revealed that Grade 2 hydronephrosis (OR = 18.3, p = 0.020), stone size > 15 mm (OR = 7.0, p = 0.012), and multiple stones (OR = 3.7, p = 0.040) significantly increased the risk of residual fragments following fURS. Conclusions: In light of our findings and published data, we can conclude that endourologists should consider the likelihood of RFs’ presence after successful stone disintegration with fURS. A detailed evaluation of the relevant factors revealed that patients with larger stones, higher degrees of hydronephrosis, and multiple calculi may carry the risk of residual fragments after these procedures. Thus, the utilization of such reliable predictive parameters may aid in selecting optimal stone removal strategies and planning subsequent interventions in the rational management of RFs.

Introduction: The aim of this study was to compare the efficacy and safety of shock wave lithotripsy (SWL) and flexible ureteroscopy (fURS) in treating unilateral moderate-sized (10–20 mm) kidney stones, with a focus on changes in quality of life (QoL). Methods: This study included 112 patients with unilateral radiopaque kidney stones. Patients were divided into two groups: SWL (n = 64) and fURS (n = 48). Treatment outcomes, including QoL changes, were evaluated comparatively between the groups. Results: Both groups were similar in terms of age, gender, stone size, and density. Short-term (4-week) stone-free rates (SFRs) were higher in the fURS group (79.17% vs. 51.56%, p = 0.003). However, at 3 months, there was no significant difference in SFRs (89.8% vs. 85.2%, p = 0.098). Pain levels, assessed using the Visual Analog Scale, showed no difference 1-h post-procedure (p = 0.338), but SWL had lower pain scores at 4 h (p = 0.002). QoL, assessed with the SF-36 questionnaire, indicated an advantage for SWL in energy/fatigue parameters (p = 0.017), with no significant differences in other domains. SWL was particularly beneficial for energy levels and emotional well-being. Conclusions: SWL’s noninvasive nature, reduced pain levels, and advantages in specific QoL parameters make it an effective treatment option for medium-sized kidney stones. While fURS offers better short-term stone clearance, SWL demonstrates comparable long-term efficacy with added QoL benefits.

Objective: This study aimed to investigate the correlation between demographic characteristics, stone size, density, and location, skin-to-stone distance (SSD), urinary parameters, and the success rate of extracorporeal shock wave lithotripsy (ESWL) in patients with ureteral stones. Material and Methods: A total of 151 patients with ureteral stones were included in this retrospective study, and ESWL treatment was successful in 116 of them. Stone size, density, and ureteral location (upper/lower and right/left) were evaluated using non-contrast computed tomography, and SSD was measured. Demographic characteristics [age, gender, and BMI (Body Mass Index)] and complete urinalysis parameters (pH, specific gravity, protein, leukocytes, erythrocytes, casts, and various crystal types) were recorded. The impact of these factors on ESWL success was statistically analyzed. Results: A significant negative correlation was found between ESWL success and stone density [in Hounsfield units (HU)], SSD, and patient age. Treatment success was lower for hard stones (HU ≥ 1000) compared to soft stones (HU < 1000) (ESWL successful: 28/45 (62%) vs 88/106 (83%), p = 0.006). Similarly, patients with successful ESWL had lower ages and SSD compared to those with unsuccessful outcomes (41±13 vs 45±9 years and 117±18 vs 125±17 mm, respectively). Additionally, stones with higher density were found to be larger compared to those with lower density, with a low-level positive correlation (9.0(4.8-15.0) vs 7.8(4.2-15.0) mm, p=0.0458; r=0.240, p=0.0029). Binary regression analysis revealed that SSD, stone density (HU), and stone location significantly influenced ESWL success and could predict outcomes with 78.8% accuracy (p=0.005, 0.002, and 0.014, respectively). Conclusion: Increased stone density, longer SSD, and advanced age can decrease the success of ESWL treatment. This study highlights the importance of considering these variables when planning ESWL treatment.