COMPARING RESULTS OF TWO DIFFERENT SIZED URETERO-RENOSCOPES IN TREATMENT OF URETERIC STONES

Purpose: To compare success and complications using 6fr (thin) semirigid URS with 8fr (standard) semirigid URS in treating ureteric stones. Material & Methods: Group 1 , 52 patients treated for ureteric stones with thin URS and the same number treated with standard URS in Group 2 , were compared retrospectively using a matched pair analysis. The size , side ,location and impaction of the stones and also the age, gender, body mass index (BMI) and the presence of hydro-uretronephrosis were used as matching parameters, stones were fragmented with pneumatic energy. Results : The matching parameters were comparable between the 2 groups. The stone free rates were 88.5% and 84.6% in group 1 and 2 , mean operative time was 32.7+- 5.8 min and 30.2+- 5.4 min in group 1 and 2 respectively. Post operative haematuria was seen in 1.9% and 13.5% patients in group 1 and 2 , Ureteral balloon dilatation was seen in 1.9% in group 1 as compared to 13.5% in group 2, Mucosal injury was seen in 1.9% and 13.5% in group 1 and 2 respectively .No major complications seen in either groups. Conclusion: Though stone free status and operative time was similar in both groups, a thin 6fr URS can reduce the need for ureteric dilatation and has less minor complications as mucosal injury and post operative haematuria in patients.

Effect of perioperative alpha1-blocker on non-stented ureteroscopic laser lithotripsy for ureteric stones

Background Nowadays, ureteroscopy is the first line of surgical treatment of ureteric stones and holmium YAG laser is commonly used in stone fragmentation. Guidelines 2018 recommended not fixing ureteric stent in uncomplicated ureteroscopy. Therefore, when we decrease intra-operative dilatation, we may decrease the complicated ureteroscopy. Objective To assess the safety, efficacy and outcome of peri-operative alpha1 blockers on non-stented ureteroscopic laser lithotripsy for ureteric stones. Patients and Methods Our study was conducted at Urology Department, Ain Shams University Hospitals and National Institute of Urology and Nephrology starting from September 2017 to December 2018. Sixty patients with lower ureteric stone included in this study underwent non-stented laser lithotripsy and were divided into two equal groups; group A (tamsulosin) and group B (no tamsulosin). Results Our study revealed that using peri-operative tamsulosin statistically reduced the need for ureteric dilatation, mean operative time, mean hospital stay, post-operative pain, the need for pain medications and post-operative lower urinary tract symptoms. Conclusion Administration of peri-operative tamsulosin seems to significantly decrease the need for intra-operative dilatation, post-operative LUTs, post-operative pain and the need for analgesia and shorten operative time and hospital stay.

Congenital Midureteric Stricture: Challenges in Diagnosis and Management

Background. Congenital midureteric stricture (MUS) is a rare malformation. We report our experience with five cases seen over a period of 4 years from 2010 to 2014.Materials and Methods. The study was based on the retrospective analysis of five patients diagnosed as having MUS. Diagnosis was suspected after fetal ultrasonography (USG) in one patient and magnetic resonance urography (MRU) in four patients. Retrograde pyelography (RGP) was performed on three patients. The final diagnosis was confirmed during surgical exploration in all the patients.Results. MRU was found to be a good investigation method. It showed the site of obstruction in the ureter in all instances. Intravenous urography detected proximal ureteric dilatation present in two of the patients. RGP delineates the level of stricture and the course of ureter, as shown in our cases. All patients had significant obstruction on the affected side. Four patients underwent ureteroureterostomy, all of whom had satisfactory results. In one patient, ureteric reimplantation was carried out due to distal small ureteric caliber.Conclusion. This rare entity is often misdiagnosed initially as pelviureteric junction obstruction. MRU is an excellent option for the anatomical location and functional assessment of the involved system. At the time of surgical correction of a ureteral obstruction, RGP is a useful adjunct for delineating the stricture level and morphology.

Persistent Ureteric Dilatation due to Pelvic Actinomycosis Presenting as Pelvic Inflammatory Disease

Actinomycesis a Gram-positive, filamentous bacterium that normally colonizes mucosal areas. Pelvic actinomycosis is a chronic granulomatous disease caused byActinomyces israeliithat frequently mimics ovarian tumors during presentation. It is diagnosed after surgery in most of the cases. Intravenous penicillin is the most preferred therapeutic agent, and it requires hospitalization up to one month. Pelvic actinomycosis is a rare cause of ureteric obstruction and renal failure. The final diagnosis is usually difficult and often apparent only after histological examination of an operative specimen. The present case led us to consider the etiology and clinical findings and to review the management of reported cases involving ureteric obstruction.

The difficult ureter: what is the incidence of pre-stenting?

INTRODUCTION Difficulty may be encountered with retrograde access for rigid and flexible ureterorenoscopy (URS) due to anatomic abnormalities, a narrow ureteric lumen, tortuous ureteric path or previous instrumentation. Ureteric dilatation using a balloon or tapered dilator can occasionally fail and will usually lead to the placement of a ureteric stent. We present our experience and incidence of pre-stenting after failed standard access and dilatation techniques, the aim being to quote a figure for the patient at the time of consent. PATIENTS AND METHODS Data were collected prospectively from a single surgeon at a regional tertiary referral stone unit. The outcomes of those patients pre-stented, for failed access, were recorded. RESULTS Between December 2007 and December 2008, a total of 119 patients underwent flexible and rigid URS. Mean patient age was 49 years (range, 19–86 years). Of these, 107 cases were undertaken for urolithiasis and 12 cases for diagnosis of upper tract malignancy. 12% (13/107) of cases were for pain and non-diagnostic imaging and 8.4% (9/107) of patients were pre-stented because of failed access, without complication, and subsequently had successful interval treatment. Of the remaining successful cases of confirmed urolithiasis, 33% (28/85) and 67% (56/85) were undertaken for ureteric and renal calculi, respectively. Stone clearance rates were 83% (19/23) and 75% (3/4) for lower pole renal calculi 5–10 mm and > 10 mm in size, respectively. The overall clearance rate for lower pole calculi was 81% (22/27). The ureteric stone clearance rate was 86% (24/28) rising to 92% (24/26) in those solitary stones less than 10 mm in size. CONCLUSIONS The incidence of ureteric pre-stenting in a tertiary referral unit was 8% and should be considered and indeed discussed with patients when obtaining pre-operative consent, especially for purely elective, non-urgent, upper tract cases. The alternative for these difficult, tight ureters is extensive balloon dilatation, with the risk of trauma and the potential for long-term stricture formation.

Endometriosis Presenting as Hydronephrosis

The most serious urological complication of endometriosis is hydronephrotic renal atrophy secondary to ureteric involvement. As only half of these patients are symptomatic, it is commonly diagnosed late and more by the clinicians awareness and suspicion of this entity. We report a case of an unmarried young female who presented primarily with left loin pain of 2-year duration. She was found to have lower ureteric stricture by an IVU done by her referring doctor. Further workup at our center showed that she had pelvic endometriosis with hydronephrosis secondary to extrinsic ureteric endometriosis. She had a first-degree relative with the same disease. She had no menstrual problems. Diagnostic laparoscopy, biopsy of the lesion, ureteric dilatation with stenting, along with hormonal treatment was given to her as first line of treatment. There was no improvement of the ureteric obstruction even after 6 months of treatment. Finally, surgical excision of the endometrioma, left oophorectomy, along with resection of the ureteric stricture with uretero-ureterostomy was done. This case report includes details of her further management and outcome along with a brief review of literature.