Role of Aminophylline Intravesical Instillation on Enhancing Ureteral Dilatation prior to Ureteroscopy

Background Semi-rigid uretroscopy (URS) is a common intervention approach for lower ureteric stones. Ureteral dilatation is frequently needed before URS to enable ureter accessing. Aminophylline is known by its muscle relaxant effect and has been suggested to be effective in ureteral dilation. Objectives To evaluate the effect of intravesical administration of aminophylline on ureteroscopy and to measure intraureteral pressure Methods This prospective randomized controlled study included 50 before and after aminophylline injection. patients with lower ureteral calculi. In group A, the ureter was dilated by intravesical aminophylline whereas in group B balloon dilator was used. Intraureteral pressure was measured using pressure transducer connected to invasive pressure monitor. Results No statistically significant difference was noticed between both groups in operative time, intra operative complication, need for ureteral stenting or stone free rate. However, post-operative pain and haematuria were statistically significantly higher among balloon group compared to aminophylline group. In group A, there was statistically significant decrease in intraureteral pressure after injection of aminophylline (7.80 ± 1.71) compared to before injection (12.2 ± 1.85) with p-value < 0.001. Conclusion Aminophylline is effective in ureteral dilatation when intravesically injected with less frequent post-operative pain and hematuria.

Guidewire for Retrograde Passive Dilatation of Ureter in Pediatric Patients with Urolithiasis: A Novel Technique from a Tertiary Center in Nepal

Objective of the Study: We sought to evaluate the role of guidewire placement as ureteral stent in passive ureteral dilatation for uretero-renoscope negotiation in pediatric patients. Study Designs: This was a prospective cross-sectional study. Place and Duration of the Study: Department of Urology, Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal, (December 2019 to November 2020). Methodology: All pediatric patients (<18 years) diagnosed with more than 6mm size of distal ureter stone undergoing ureteroscopic lithotripsy under general anesthesia in which ureteroscope (4.5/6.5 Fr) negotiation and double J (DJ) ureteral stent (4 Fr) insertion could not be successful in first sitting were selected for the study. Data collection included demographics, clinical parameters, and perioperative and postoperative complications of those patients undergoing preoperative ureteral stenting with guidewire for 2 weeks for ureteroscopic management of ureteric stone after removal of guidewire. The statistical analysis of data was done using Microsoft Excel. Results: A total of 12 (41 %) cases underwent passive dilatation of ureter with guidewire. The mean age of the patients and mean stone size were 8.42 ± 1.7 years and 6.1 ±0.65mm respectively. None of the patients developed intraoperative and postoperative complications related to the procedure. Conclusion: Guidewire placement as ureteral stent for 2 weeks would result sufficient passive ureteral dilatation for the ureteroscope negotiation without any complication. PUD with guidewire is safe and effective. Additional research is necessary to determine whether the findings will be similar or not.

Ureteral Dilatation with No Apparent Cause on Intravenous Urography: Normal or Abnormal? A Pilot Study

A pilot study was done in 18 adults to assess the significance of ureteral dilatation having no apparent cause seen on Intravenous Urography (IVU). A clinicoradiological evaluation was undertaken to evaluate the cause of ureteral dilatation, including laboratory investigations and sonography of the genitourinary tract. This was followed, if required, by CT Urography (using a modified technique). In 9 out of 18 cases, the cause of ureteral dilatation on laboratory investigations was urinary tract infection (6) and tuberculosis (3). In the remaining 9 cases, CTU identified the cause as extrinsic compression by a vessel (3), extrinsic vascular compression of the ureter along with ureteritis (2), extrinsic vascular impression on the right ureter and ureteritis in the left ureter (1), ureteral stricture (2), and ureteral calculus (1). Extrinsic vascular compression and strictures did not appear to be clinically significant in our study. Hence, ureteral dilatation without any apparent cause on intravenous urogram was found to be clinically significant in 12 out of 18 (66.6%) cases. We conclude that ureteral dilatation with no apparent cause on IVU may indicate urinary tract tuberculosis, urinary tract infection (E. coli), or a missed calculus. Thus, cases with a dilated ureter on IVU, having no obvious cause, should undergo a detailed clinicoradiological evaluation and CTU should be used judiciously.