Do urologists follow the golden rule? A global urolithiasis management study by the Clinical Research Office of the Endourological Society

Introduction: The primary objective of this study was to compare surgical management options for various urolithiasis scenarios that urologists would choose for themselves vs. the options they would recommend for their patients. The secondary objective was to identify the common recommended treatments for upper urinary tract stones of various sizes and locations.Methods: Two surveys were sent by the Clinical Research Office of the Endourological Society (CROES) to members of the Endourological Society. Standard demographic information was collected. The first survey asked the urologists to recommend treatment for urolithiasis in 10 different scenarios assuming that they were the patient with stone disease. The second survey, sent eight months later, asked urologists to recommend treatment for the same 10 scenarios for a theoretical patient. Only urologists who responded to the first and the second survey were included. Recommended treatment options were compared between the surveys. Agreement between the two scenarios was measured with Cohen’s kappa. Surveys were conducted on the Internet using SurveyMonkey™. All statistical analyses were performed using R statistical program version 2.12.2.Results: The two surveys had response rates of 78% (160/205) and 84% (172/205), respectively with urologists from 38 countries. Median experience of respondents was seven years (range: 2‒30). The majority of respondents, 117 (75%), were affiliated with academic hospitals. Recommended treatments for stone disease in different scenarios were not entirely consistent when the urologists considered themselves as the patients compared to the choice they might recommend for their patients. Cohen’s kappa ranged from 0.292‒0.534 for the different scenarios. Overall, shock wave lithotripsy (SWL) and ureteroscopy (URS) were the most commonly chosen treatment options, with medical expulsive therapy (MET) and laparoscopy being the least recommended by urologists for themselves, as well as for their patients.Conclusions: Although urologists were not entirely consistent in their recommendations for stone treatment, they generally followed the “golden rule” and treated their patients as they would want to be treated. The most commonly recommended treatments for upper urinary tract stones were SWL and URS.

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Clinical Pattern of Urinary Stone Disease in Our Setting

Annals of King Edward Medical University ◽

10.21649/akemu.v15i1.25 ◽

2010 ◽

Vol 15 (1) ◽

Author(s):

Jan Muhammad Memon ◽

M. Amin Athar ◽

Anwar Ali Akhund

Keyword(s):

Urinary Tract ◽

Urinary Calculi ◽

Urinary Stone ◽

Upper Urinary Tract ◽

Stone Disease ◽

Female Ratio ◽

Urinary Stone Disease ◽

Clinical Pattern ◽

Male Predominance ◽

Urinary Tract Stones

Objectives: To study the basic clinical pattern of urinary stone disease in our setting.Study design: Descriptive study.Setting: Department of surgery of Nawabshah Medical College Nawabshah over a period of 4 years between August 2003to August 2007.Subjects: A total of 257 urolith patients with different stone burden enrolled in the study.Methodology: Structured and standardized history and clinical investigations collected in all of urolith patients. Thediagnosis of stone disease was based on history, physical examination followed by KUB x-ray, ultrasonography and IVU .Allpatients subjected to open stone surgery. The data were analyzed prospectively with outcome measures of gender, stonelocation, clinical presentation and operative procedures.Results: Out of 257 patients 181 (70.42%) were male and 76 (29.56%) female with male to female ratio of 2.3:1.The ageranged from 1 year to 80 with the mean of 25.8 years. The peak incidence of upper urinary tract stones was in 20-30 yearswhile lower urinary tract stones in both sexes were under 10 years (Table 1). Anatomical distribution of stone showed 116(45.16%) renal, 21 (8.17%) ureteric, 108 (42%) bladder and 12 (4.66%) urethral calculi (Table 2). The commonest clinicalpresentation was that of pain in 67.31% of patients associated with haematuria in 26.7% of cases. Clinical urinary tractinfection (UTI) was in 15% and 8.9% of patients had spontaneous stone passage (lithuria). The symptoms of bladder outletobstruction (BOO) including retention of urine were in 7% of cases. Calculus anuria was in 1.9% of cases and 8.1% patientshad asymptomatic stones. Bilithiasis (chole-nephrolithiasis) was in 5% of cases (Table 3). Open stone surgery included 84(32.68%) simple pylolithotomies, 15 (5.83%) extended pylolithotomies, 6 (2.33%) pylolithotomy and pyloplasty, 5 (1.94%)nephrolithotomy, 6 (2.33%) nephrectomies, 21 (8.17%) uretrolithotomy, Cystolithotomy was 113 (43.96%) cystolithotomy, 2(0.77%) urethrolithotomy and meatotomy in 5 (1.94%) of patients.Conclusion: Urolithiasis is increasing problem with high frequency of bladder stones and male predominance in our part ofSindh province. Open surgery is still needed to treat the patients where modern and minimally invasive therapeutic modalitiesare out of reach and non-availability in public sector. Establishment of modern stone clinics in rural setup is the need oftoday’s medical practice.Keywords: Urinary calculi, Clinical profile, Open stone surgery.

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Are upper urinary tract stones more common in more deprived populations?

Journal of Clinical Urology ◽

10.1177/2051415819884839 ◽

2019 ◽

Vol 13 (3) ◽

pp. 228-234

Author(s):

Robert S Radcliffe ◽

Steven Miller ◽

Simon T Williams ◽

Richard FJ Stanford

Keyword(s):

Urinary Tract ◽

Poisson Regression ◽

Upper Urinary Tract ◽

Stone Disease ◽

Level Of Evidence ◽

Urinary Tract Stones ◽

Calculus Formation ◽

Urinary Tract Stone ◽

The Relationship ◽

Index Of Multiple Deprivation

Purpose: To examine the relationship between deprivation and upper tract calculus formation, and provide a contemporary estimate of the incidence of upper urinary tract stone disease. Methods: A retrospective review of hospital episodes for patients presenting to our institution with upper urinary tract stone disease in a 3-year period between 2010 and 2014. Incidence of stone disease was calculated and stratified according to deprivation, as measured by the index of multiple deprivation (IMD) and its subdomains. Poisson regression was used to model the relationship between deprivation and stone disease. Results: The overall incidence of upper urinary tract stone disease was 115 patients/100,000 person-years (95% confidence interval (CI) 108–122 per 100,000 person-years). There is a link between the IMD (as well as a number of its subdomains) and stone disease. The rate of incident stone disease was 50.6% higher in the most deprived quintile of the IMD when compared to the least deprived ( p < 0.001). Multivariate Poisson regression found that education, skills and training deprivation was the subdomain that predicted stone disease most strongly, with the incidence rate ratio being 1.15 (95% CI 1.053–1.261) for each increase in quintile. Conclusion: This study provides a contemporary measure of the incidence of upper urinary tract stone disease derived from a population in the Midlands of England. It informs our understanding of the link between types of deprivation and stone occurrence. Level of evidence: 2b

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Faculty Opinions recommendation of Ultra-Mini-Percutaneous Nephrolithotomy for the Treatment of Upper Urinary Tract Stones Sized between 10-20 mm in Children Younger Than 8 Years Old.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.739164961.793580864 ◽

2020 ◽

Author(s):

M Hammad Ather

Keyword(s):

Urinary Tract ◽

Percutaneous Nephrolithotomy ◽

Upper Urinary Tract ◽

Urinary Tract Stones

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A review of the contemporary management of upper urinary tract urothelial carcinoma

Journal of Clinical Urology ◽

10.1177/2051415817717906 ◽

2017 ◽

Vol 11 (1) ◽

pp. 51-57

Author(s):

Abhishek Reekhaye ◽

Seshadri Sriprasad ◽

Sanjeev Madaan

Keyword(s):

Urinary Tract ◽

Urothelial Carcinoma ◽

Treatment Options ◽

Treatment Strategies ◽

Upper Urinary Tract ◽

Rare Tumour ◽

Endoscopic Techniques ◽

Upper Tract ◽

Urothelial Carcinomas ◽

Urinary Tract Urothelial Carcinoma

Upper tract urothelial carcinoma (UTUC) is relatively rare and accounts for approximately 5% of all urothelial carcinomas. The estimated annual incidence of UTUC in Western countries is about two new cases per 100,000 inhabitants. The management of patients with upper tract urothelial carcinomas has changed significantly over the last decade with improved diagnostic techniques and treatment options. The gold-standard treatment used to be open radical nephroureterectomy with removal of the ipsilateral bladder cuff. The use of minimally invasive techniques for the diagnosis and management of upper urinary tract urothelial carcinoma is however expanding and has led to a paradigm shift in treatment strategies of upper tract urothelial carcinomas. In this article, we review the current diagnostic modalities and various endoscopic techniques being currently used in the management of this relatively rare tumour.

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Flexible ureterorenoscopy to treat upper urinary tract stones in children

Urolithiasis ◽

10.1007/s00240-018-1083-5 ◽

2018 ◽

Vol 48 (1) ◽

pp. 57-61 ◽

Cited By ~ 1

Author(s):

Ahmed Suliman ◽

Tariq Burki ◽

Massimo Garriboli ◽

Jonathan Glass ◽

Arash Taghizadeh

Keyword(s):

Urinary Tract ◽

Upper Urinary Tract ◽

Flexible Ureterorenoscopy ◽

Urinary Tract Stones

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The effect of urinary tract calculosis to levels of low molecular inhibitors of crystallization in the urine

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0602040m ◽

2006 ◽

Vol 134 (1-2) ◽

pp. 40-43

Author(s):

Dragica Milenkovic ◽

Natasa Lalic

Keyword(s):

Urinary Tract ◽

Shock Waves ◽

Stone Formation ◽

Upper Urinary Tract ◽

Therapeutic Procedure ◽

Residual Stone ◽

Extracorporeal Shock Waves ◽

Urinary Levels ◽

Urinary Tract Stones ◽

Pre Treatment

The incidence of urinary tract calculosis continuously progresses. The triggering event in the process of stone formation is decreased urinary level of crystallizing inhibitors. The aim of our study was to investigate whether the existing stone or applied therapeutic procedure - extracorporeal shock waves lithotripsy (ESWL) - has effect to urinary levels of Mg, citrate and pyrophosphate. Study included 128 patients with the upper urinary tract stones. ESWL using the Lithostar (Siemens) device was used as a mode of treatment. Out of all patients, 76 (59%) were free of stone particles before 1 month, while 52 (41%) had residual stone fragments even 3 months after ESWL. Mg, citrate and pyrophosphate were measured in 24hurine specimens: before, between days 2 and 3, as well as 1 and 3 months after ESWL. The analysis of the results revealed that stone itself had no effect on urinary crystallizing inhibitors. Detected increased urinary levels of Mg, citrate and pyrophosphate after ESWL, compared with pre-treatment values, could be attributed to applied therapeutic procedure.

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