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Stone Size (stone + size)
Selected AbstractsCOMPARING BALLOON DIAMETER ON PERFORMING ENDOSCOPIC PAPILLARY BALLOON DILATATION WITH ISOSORBIDE DINITRATE DRIP INFUSION FOR REMOVAL OF BILE DUCT STONESDIGESTIVE ENDOSCOPY, Issue 4 2004Hiroshi Nakagawa Background:, Endoscopic papillary balloon dilatation (EPBD) is one of the methods to remove bile duct stones. EPBD might preserve the function of the sphincter of Oddi despite the potential risk of acute pancreatitis. There are only a few reports of EPBD reducing the risk of acute pancreatitis and, at same time, preserving the function of the sphincter of Oddi. Methods:, We performed EPBD for bile duct stone removal in 60 patients using two balloons with different diameters. Patients were randomized to EPBD with a 6 mm balloon (n = 30) or an 8 mm balloon (n = 30). In both groups, isosorbide dinitrate (ISDN) was infused in a rate of 5 mg/h while low pressure EPBD were being performed. The pressure of the sphincter of Oddi was observed before and after the EPBD procedures. Also, serum amylase level after EPBD was observed for both groups. Results:, Serum amylase level of the 6 mm group was signi,cantly higher than that of the 8 mm group (P < 0.05). Acute pancreatitis occurred in two patients ( 6.7%) in the 6 mm group whereas no case was observed for the 8 mm group. The rates of duct clearance were 93% in the 6 mm group and 100% in the 8 mm group. Stone removals were dif,cult in seven cases with 6 mm balloon dilatations due to the narrow ori,ces of the papilla. In the 6 mm group, there was no signi,cant difference between the basal sphincter of Oddi pressure (BSOP) and the phasic sphincter of Oddi pressure (PSOP) before and after EPBD. However in the 8 mm group, the BSOP observed after the EPBD procedure was signi,cantly higher than BSOP before the treatments. Within this group, BSOP values after EPBD were preserved by approximately 80% of the BSOP values before the treatments. In contrast, there was no signi,cant difference in PSOP before and after the treatments. Regarding the stone numbers, no signi,cant difference was observed in BSOP before and after the treatments for the 6 mm group with less than two stones. Also, as for stone size, no signi,cant difference was observed in BSOP before and after the treatments for the 6 mm group with stones of less than 6 mm in diameter. Conclusion:, We are now conducting EPBD with ISDN infusion using a 6 mm balloon for a patient who has less than two stones with size not exceeding 6 mm in diameter. An 8 mm balloon is used for a patient with more than two stones or a stone greater than 6 mm in size. [source] Systemic inflammatory response syndrome after percutaneous nephrolithotomy: An assessment of risk factorsINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2008Liang Chen Objectives: To analyze the risk factors for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) and to quantitatively predict the probability of SIRS after PCNL. Methods: Medical records on 209 patients who underwent PCNL were retrospectively analyzed. The ,2 test, the t -test and a logistic regression model were used to identify key risk factors of SIRS after PCNL. A predictive equation was then formulated to assess the risk of SIRS according to the results from the logistic model. Subsequently, the accuracy of the equation by calculating sensitivity, specificity, overall correct percentage, and positive and negative predictive values was tested. Results: The incidence of SIRS after PCNL was 23.4%. The key risk factors for SIRS following PCNL were: the number of tracts, receipt of a blood transfusion, stone size, and presence of pyelocaliectasis. Other factors added no independent risk to the development of SIRS. The calculated values for sensitivity, specificity, overall percentage correct, positive predictive value and negative predictive value were 44.9%, 95.0%, 83.3%, 73.3%, and 84.9%, respectively. Conclusions: Number of tracts, receipt of a blood transfusion, stone size and presence of pyelocaliectasis are identified as the key risk factors for SIRS after PCNL. The predictive equation allows for an individualized and quantitative assessment of the probability of SIRS after PCNL. [source] Lower pole ratio: A new and accurate predictor of lower pole stone clearance after shockwave lithotripsy?INTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2004YAN KIT FONG Abstract Background: Lower pole spatial anatomy is an important determinant of success after extracorporeal shockwave lithotripsy. In the present study, we determine whether there is a significant relationship between lower pole ratio (infundibular length : infundibular width) on preoperative intravenous urograms and stone fragment clearances after shockwave lithotripsy. Methods: A total of 42 patients with isolated lower pole stones were retrospectively reviewed. Anatomical factors, such as infundibular length, width and infundibulopelvic angle were measured and the lower pole ratio was calculated on pretreatment intravenous urogram. Stone fragment clearance was assessed at three months with a plain abdominal X-ray. Results: The overall three-month stone-free rate was 62%. Mean stone size ± SD was 10 ± 4.8 mm, mean infundibular length was 21.7 ± 6.9 mm, mean infundibular width was 6.1 ± 2.3 mm, mean infundibulopelvic angle was 62.1 ± 30.1 degrees and mean lower pole ratio was 4.3 ± 2.8. Stone-free status after shockwave lithotripsy was significantly related to infundibular length and width as well as to lower pole ratio, but not to infundibulo-pelvic angle. Infundibular length less than 30 mm, width greater than 5 mm and lower pole ratio less than 3.5 were noted to have an improved three-month stone-free rate (P = 0.049, 0.01 and <0.01, respectively). Conclusion: Caliceal anatomy is an important consideration for lower pole stone clearance after shockwave lithotripsy. The present study suggests that a lower pole ratio of less than 3.5, which considers both infundibular length and width, is a promising predictor for stone-free status. [source] The Learning Curve of Resident Physicians Using Emergency Ultrasonography for Obstructive UropathyACADEMIC EMERGENCY MEDICINE, Issue 9 2010Timothy B. Jang MD Abstract Background:, Given the time, expense, and radiation exposure associated with computed tomography (CT), ultrasonography (US) is considered an alternative imaging study that could expedite patient care in patients with suspected obstructive uropathy. However, there is a paucity of literature regarding bedside US for obstructive uropathy in the emergency department (ED), and it is unknown how much experience is required for competency in such exams. Objectives:, The objective was to assess the learning curve for the detection of obstructive uropathy of resident physicians training in ED bedside US (EUS) during a dedicated EUS elective. Methods:, This was a prospective cohort study of residents participating in an EUS elective. Patients presenting with acute abdominal or flank pain suggestive of an obstructive uropathy were enrolled and underwent EUS prior to noncontrast CT. Physicians who had previously performed at least 10 EUS exams for obstructive uropathy recorded results on a standardized data sheet, which was subsequently compared to the results of noncontrast CT read by board-certified radiologists blinded to the results of the EUS. In addition to an unadjusted chi-square test for trend, a multivariable logistic regression analysis, adjusting for stone size and operator, was performed. Finally, generalized estimating equations were used to describe test characteristics while accounting for potential clustering between exams by operator. Results:, Twenty-three resident physicians participated and enrolled a convenience sample of 393 patients. A total of 157 patients (40%) were diagnosed with an obstructing ureterolith, and three (1%) were diagnosed with nonobstructing ureterolithiasis. An unadjusted chi-square test for trend demonstrated a statistically significant increase in both sensitivity (,2 = 11.4, p = 0.02) and specificity (,2 = 6.4, p = 0.04) for each level of increase in number of exams. On multivariable regression analysis, when adjusting for size of stone and operator, for every five additional exams after the first 10 EUS exams, the odds ratio for a true positive for obstruction increased by 1.7 (95% confidence interval [CI] = 1.2 to 2.5, p = 0.003). After accounting for clustering of exams by operator, overall EUS sensitivity and specificity for obstructive uropathy were 82% (95% CI = 77% to 87%) and 88% (95% CI = 85% to 92%). Stratifying by number of exams, the sensitivity was 72% (95% CI = 62% to 80%) for the 11th through 20th exams, 90% (95% CI = 83% to 96%) for the 21st through 30th exams, and 95% (95% CI = 91% to 99%) for the 31st through 43rd exams. Likewise, specificity was 82% (95% CI = 75% to 89%) for the 11th through 20th exams, 90% (95% CI = 85% to 95%) for the 21st through 30th exams, and 92% (95% CI = 86% to 98%) for the 31st through 50th exams. Conclusions:, Physicians training in EUS may be able to accurately assess for obstructive uropathy after 30 exams. ACADEMIC EMERGENCY MEDICINE 2010; 17:1024,1027 © 2010 by the Society for Academic Emergency Medicine [source] The contribution of stone cover to biological activity in the Negev desert, IsraelLAND DEGRADATION AND DEVELOPMENT, Issue 1 2001I. Lahav (Lavian) Abstract Ancient valley agriculture in the northern Negev highlands was based on the principle of directed collection of water and eroded material from the slopes and their consequent flow towards the valleys. The stones on these slopes were therefore removed and/or collected into piles known as ,grape mounds'. The aim of this study was to understand the contribution of stone cover and slope-facing to biological activity in soil. Soil samples from a depth of 0,5,mm from the soil surface were collected during the study period (December 1994,March 1996) from northern and southern hill slopes, from under limestones and between stones. Soil moisture, organic matter, chlorophyll-a and soil respiration were determined. The results obtained in field and laboratory studies demonstrated differences between the northern and southern slopes. The stone cover on the northern slope made up 33 per cent and in the southern slope 23 per cent, stone size ranging from 15,50,cm2 and 15,35,cm2, respectively. Soil moisture content varied from 12 per cent in December 1994 on both slopes to one-quarter of the initial value during the dry period. Organic matter content reached a maximal level of 14 per cent and 16 per cent on the northern and southern slopes, respectively. Values of chlorophyll-a on both the northern and southern slopes were 0.38,,g,g,1 dry soil during the wet season, decreasing to 0.05,,g,g,1 dry soil during the dry period. Soil samples from under the stones on both slopes produced high levels of CO2, ranging between 50 and 100,,g CO2,g;,1 dry soil h,1, whereas in the control samples the levels ranged between 30 and 70,,g CO2,g,1 dry soil h,1. In conclusion, the stone cover apparently plays an important role in the maintenance of biological activity through its contribution to slope biotope stability. Copyright © 2001 John Wiley & Sons, Ltd. [source] A second cycle of tamsulosin in patients with distal ureteric stones: a prospective randomized trialBJU INTERNATIONAL, Issue 12 2009Francesco Porpiglia OBJECTIVE To evaluate, in a prospective randomized pilot study, the effectiveness and safety of tamsulosin, administered in patients with distal ureteric stones and who have already undergone an unsuccessful first cycle of medical expulsive therapy (MET). PATIENTS AND METHODS We evaluated the effectiveness and safety of tamsulosin, administered as a further therapy, in patients previously unsuccessfully treated with combined expulsive 10-day therapy (tamsulosin + deflazacort) for distal ureteric stones. Ninety-one patients were enrolled and randomized into two groups, each receiving a different therapy for 10 days. Group A (46 patients) received a further cycle of tamsulosin (0.4 mg daily), and group B (45) did not. Age, gender, stone size, time to expulsion, number of acute episodes of colic during treatment and analgesic consumption were recorded. Patients who were not stone-free after the study period had ureteroscopy. The results were compared statistically using Student's t -, chi-square test and Fisher's exact test. RESULTS The groups were comparable inage, gender and stone size (5.93 mm for group A and 6.03 mm for group B). The expulsion rate was significantly higher in group A (80%) than in group B (49%) (P < 0.01), whilst there were no differences between the groups in the number of colic episodes and analgesic use. There were no reported side-effects of medical therapy. CONCLUSIONS A second cycle of 10 days of MET with tamsulosin in nonresponders to a 10-day first cycle of MET with tamsulosin and deflazacort is safe and effective, and therefore should be considered as an option in the management of uncomplicated distal ureteric stones. [source] Ureteric stents compromise stone clearance after shockwave lithotripsy for ureteric stones: results of a matched-pair analysisBJU INTERNATIONAL, Issue 1 2009Athanasios N. Argyropoulos OBJECTIVE To identify the effect of the presence of a ureteric stent on the outcome of extracorporeal shockwave lithotripsy (ESWL), by comparing patients with ureteric stones with matched-pair analysis. PATIENTS AND METHODS Patients undergoing ESWL with the Sonolith Vision lithotripter (Technomed Medical Systems, Vaulx-en-Velin, France) were identified from our prospectively maintained database. Only adult patients with a solitary, radio-opaque, previously untreated ureteric stone were considered for further analysis. A follow-up of ,3 months with a plain abdominal film was used to identify residual fragments. Patients were exactly matched for gender, side, location in the ureter and size (in two dimensions, within ±2 mm). If both diameters could not be matched exactly, the size was extended to ±1 mm and then to ±2 mm of both diameters. An effort was finally made to match patients by age. The treatment outcome in terms of stone-free rates was assessed and compared using McNemar's test. RESULTS In all, 45 patients with a ureteric stent in place during ESWL were identified. The only patient who could not be adequately matched was a 40-year-old man with an 8 × 3 mm stone in the upper ureter. The best/closest match for age was selected. Most stones were in the upper ureter (77%); the mean stone size was 8.5 and 8.6 mm, respectively, with no statistical differences between the groups for age and size of stones (P = 0.41 and 0.86, Student's t -test). In 12 pairs, only patients with no stent were stone-free, compared to two pairs where the patient with a stent was stone-free. Using McNemar's test, the odds ratio was 6.0 (95% confidence interval 1.3,55.2) and the difference between the groups was statistically significant (P = 0.016). CONCLUSION These results show that the presence of a stent is associated with a worse outcome after ESWL for ureteric stones. Ureteric stents should still be used in cases of obstruction, when there is a risk of sepsis, and in patients with intolerable pain or deteriorating renal function. However, their use in patients offered ESWL for ureteric stones should be considered with caution. [source] Open mini-access ureterolithotomy: the treatment of choice for the refractory ureteric stone?BJU INTERNATIONAL, Issue 6 2003D.M. Sharma OBJECTIVE To report the experience in one centre of the efficacy and safety of open mini-access ureterolithotomy (MAU) and to discuss relevant current indications. PATIENTS AND METHODS MAU was undertaken in 112 patients (mean age 38 years, range 26,57) between 1991 and 2001; the details and outcomes are reviewed. The mean (range) stone size was 12 (8,22) mm, with 30 stones in the upper, 69 in the mid- and 13 in the lower ureter. In 15 cases the stones were impacted and there were signs of infection in the proximal ureter. RESULTS MAU was successful in 111 patients; the one failure was caused by proximal stone migration early in the series. The mean (range) operative duration was 28 (10,44) min and the hospital stay 42 (24,72) h; 33 patients were in hospital for 24 h, 72 for 48 h and seven for 72 h. The blood loss was minimal, at 50 (30,150) mL. The drain was removed after 5 (5,7) days. Patients reported using opioid or nonsteroidal anti-inflammatory analgesia for a mean of 4 (1,7) days after surgery. The mean time to resumption of work was 16 (8,35) days. CONCLUSIONS MAU is a safe and reliable minimally invasive procedure; its role is mainly confined to salvage for failed first-line stone treatments but in selected cases, where a poor outcome can be predicted from other methods, it is an excellent first-line treatment. [source] | ||||||||||