Rare Case of Adrenal Hemangioma Discovered Incidentally during Renal Colic Investigation.

BACKGROUND Hemangiomas of the adrenal gland are rare benign non-functional tumors arising from the gland's vascular endothelium. Adrenal hemangiomas are rare in clinical settings, often discovered incidentally during an unrelated diagnostic investigation. CASE REPORT A 39-year-old man presented with a heterogeneous, enhancing 4.56×4.24×3.9-cm mass originating from the right adrenal gland's lateral limb, discovered incidentally on computed tomography (CT) to investigate renal colic. He was routinely followed up for 2 years with serial CT scans; the mass exhibited considerable growth compared with baseline, with a relatively stable appearance with hyperdense soft tissue component, fat, and foci of calcification. Dexamethasone suppression test demonstrated suppressed cortisol response, indicating a non-functional mass. Therefore, laparoscopic right adrenalectomy was performed, owing to the benign nature of the preoperative diagnosis of myelolipoma and mass size. The patient experienced an uneventful recovery, with no perioperative complications. The resected mass was 5×4×4 cm in size and weighed 30 g. Histopathology confirmed adrenal hemangioma. Serial sectioning revealed an encapsulated lesion with heterogeneous solid and cystic surfaces. Light microscopy examination showed dilated and congested vascular channels lined by flattened endothelium. Focal mature adipose tissue was seen. CONCLUSIONS The infrequent occurrence of adrenal hemangiomas and their nonspecific clinical and radiological presentation results in a considerable diagnostic challenge and, often, misdiagnosis. Surgical resection is usually necessary to exclude malignant disease, alleviate pressure-related symptoms, and decrease risk of retroperitoneum hemorrhage. These lesions are associated with a good prognosis. One limitation of this report is the lack of preoperative adrenal magnetic resonance imaging of the incidental adrenal mass.

[Renal colic]. / Steinkolik.

INTRODUCTION: Renal colic accounts for 5-10% of all emergency department visits, making it a common condition in acute medicine. The typical clinical presentation is an early indication of urolithiasis. DIAGNOSIS: Diagnostic measures include laboratory tests, ultrasound, and low-dose noncontrast computed tomography (CT) scans. Kidney, ureter, bladder (KUB) plain film radiography has been widely replaced by low-dose noncontrast CT with similar radiation dosage. In special patient groups such as children or pregnant women, ionizing radiation should be avoided if possible. TREATMENT: General measures involve pain management (non-steroidal anti-inflammatory agents, opioids) and empirical antibiotic treatment for suspected bacterial infection. Depending on the location/size of the stone, pharmacological stone expulsion therapy may be considered. In cases of obstructive pyelonephritis or acute renal insufficiency, early urinary drainage (JJ stent/nephrostomy) is recommended. Definitive stone removal may be performed primarily in some cases (rather small and rather distal ureterolithiasis). It is common to schedule stone removal as a secondary intervention.

Urgent ureterorenoscopy as a primary treatment for ureteral stone: why not?

To evaluate the feasibility of urgent ureteroscopy (uURS) and elective ureteroscopy (eURS) in the management of patients with renal colic due to ureteral stones. Patients who were operated for ureteral stones between September 2020 and March 2022 were determined retrospectively. The patients who were operated within the first 24 h constituted the uURS group, while the patients who were operated after 24 h were classified as eURS. No limiting factors such as age, gender and concomitant disease were determined as inclusion criteria. Patients with bilateral or multiple ureteral stones, bleeding diathesis, patients requiring emergency nephrostomy or decompression with ureteral JJ stent, and pregnant women were not included. The two groups were compared in terms of stone-free rate, complications, and overall outcomes. According to the inclusion-exclusion criteria, a total of 572 patients were identified, including 142 female and 430 male patients. There were 219 patients in the first group, the uURS arm, and 353 patients in the eURS arm. The mean stone size was 8.1 ± 2.6. The stone-free rate was found to be 87.8% (502) in general, and 92 and 85% for uURS and eURS, respectively. No major intraoperative or postoperative complications were observed in any of the patients. Urgent URS can be performed effectively and safely as the primary treatment in patients with renal colic due to ureteral stones. In this way, the primary treatment of the patient is carried out, as well as the increased workload, additional examination, treatment and related morbidities are prevented.

Urologic Presentation of Unicentric Pediatric Castleman Disease in the Setting of Acute Renal Colic.

An 11-year-old otherwise healthy female presented with renal colic and during computed tomography imaging evaluation, she was found to have a right distal ureteral stone with associated hydroureteronephrosis, medially deviated ureter, and 4-cm solid retroperitoneal mass. The mass was palpable on physical exam and was further categorized with magnetic resonance imaging, ultrasound, and laboratory testing. A multidisciplinary team approach, including pediatric surgery, radiology, oncology, and urology, led to the patient undergoing a right retrograde pyelogram, ureteroscopy with stent placement, and laparoscopic excision of retroperitoneal mass. Her pathology revealed lymphoid hyperplasia with histologic features of Castleman disease.

[Obstructive uropathia in pregnant women: results of treatment depending on the etiopatogenetic factor of development].

Actuality. The development of renal colic in pregnant women is one of the most common reasons for visiting a hospital that is not associated with obstetric pathology. Given the pharmacological and diagnostic limitations during gestation, the problem of expanding the renal cavitary system in pregnant women, as well as the choice of treatment tactics, remains a difficult clinical task. MATERIALS AND METHODS: The study group included 537 patients with obstructive uropathy with a gestation period of 5 to 36 weeks, who were hospitalized from January 2018 to January 2022 at the GBUZ GKB named after. S.S. Yudina DZM. Depending on the etiopathogenetic obstructive uropathy, the patients were divided into 3 groups: group I - 201 (37.4%) patients with gestational pyelonephritis (the presence of a systemic inflammatory response syndrome) and expansion of the renal cavitary system without confirming the diagnosis of urolithiasis; group II - 216 (40.2%) patients with renal colic (presence of pain without signs of a systemic inflammatory reaction) and enlargement of the renal cavitary system not associated with urolithiasis; group III - 120 (22.4%) pregnant women with an expansion of the cavitary system of the kidney caused by urolithiasis, both with and without signs of a systemic inflammatory reaction. Age, body mass index and previous number of pregnancies in all groups did not differ. The mean age of the patients in the three groups was 26.1 years, with a mean gestational age of 20.8 weeks. In 433 (80.6%) patients, pain was observed in the lumbar region on the right, in 83 (15.5%) - on the left, the bilateral nature of the process - in 21 (3.9%) patients. RESULTS: In group I, despite ongoing conservative therapy, 129 (64.2%) pregnant women received an internal ureteral stent. After 2-4 weeks of follow-up, the ureteral stent was removed in all patients. As a result, a short-term drainage method (up to 4 weeks) was effective in 90.1% of pregnant women, and in 13 (9.9%) patients, it was necessary to re-insert the stent, followed by a routine replacement of the drain every month. Considering the pain syndrome among patients of group II, drainage was performed in 80 (37%) pregnant women. Routine stent replacement was required in 2 (2.3%) patients. In group III, the location of the calculus in the pyelocaliceal system was in 28 (23.3%) patients, in the ureter - in 92 (76.7%) patients. Independent passage of the calculus was noted in 8 (6.7%) pregnant women, ureteroscopy without prior stenting was performed in 31 (25.8%) pregnant women with ureteral calculus. The remaining 81 (67.5%) pregnant women underwent stent placement at the first stage. When the stone was localized in the ureter, 32 (22.7%) patients underwent contact laser ureterolithotripsy and 21 (17.5%) patients underwent ureterolithoextraction. When a stone was located in the kidney, 28 (23.3%) pregnant women underwent pyelocalicolithotripsy. Achievement of the stone-free status was observed in 92.8%. CONCLUSION: Obstructive uropathy in pregnant women requires identification of the cause and a multidisciplinary approach. Long-term drainage of the urinary tract should be avoided and short-term drainage should be preferred. Surgical treatment of urolithiasis, regardless of gestational age, is an effective and safe method.

Enabling national improvement in quality of care for renal colic.

OBJECTIVES: To report the results of a clinical audit conducted by the British Association of Urological Surgeons (BAUS) of ureteric stone care pathways, with results reported with reference to national quality standards. PATIENTS AND METHODS: The BAUS conducted a clinical audit of all patients presenting as an emergency to 107 hospitals in England during November 2020 with ureteric stones. All patients were followed up until 31 March 2021 and the inpatient and outpatient management received was recorded. RESULTS: Data for 2192 patients across 117 units were submitted. The median (interquartile range [IQR]) number of patients per unit was 16 (9-27); 70% of patients were male and the median (IQR) patient age was 46 (34-59) years. Initial management was conservative treatment for 70% of patients. Overall, primary shockwave lithotripsy was performed in 34% of patients and primary ureteroscopy in 23% of cases when surgical intervention was required to treat the stone. However, 40% of patients in whom active intervention was appropriate underwent placement of a temporizing ureteric stent rather than undergo definitive surgical intervention at the outset. Female patients were less likely to have a computed tomography (CT) scan of the kidneys, ureters and bladder performed within 24 h of presentation (13% vs 7.3% for men [chi-squared P = 0.01]) and to be given correct analgesia (66% vs 73% for men [chi-squared P = 0.03]). Patients aged 60 years or older were also significantly less likely to be offered nonsteroidal anti-inflammatory drug analgesia appropriately. In total, 87% of patients had their calcium measured within the last 2 years and 73% of patients had evidence of being offered stone prevention diet and fluid advice. CONCLUSIONS: The audit demonstrates that the National Institute of Health and Care Excellence Quality Standards are both measurable and achievable. However, there was considerable variation in the delivery of these standards, including with regard to sex and age, highlighting inequalities for patient care across the UK.

Predictors of successful emergency shock wave lithotripsy for acute renal colic.

The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6-12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.

[Not all low back pain is renal colic]. / No todo dolor lumbar es un cólico nefrítico.

Low back pain is one of the most frequent reasons for consultation in primary care. Sometimes it is not easy to make a good differential diagnosis, because the number of pathologies that can express themselves with such symptoms is very wide and a complementary test or referral to the reference hospital is not always indicated. The following is a clinical case of a 59-year-old female patient with a history of dyslipidemia treated with ezetimibe, who consulted again for breakthrough low back pain, which was finally diagnosed as a penetrating ulcer of the abdominal aorta, treated endovascularly by the vascular surgery service. The clinical case aims to provide an overview of the acute treatment of aortic syndrome, showing the differences compared to the management of other common pathologies in primary care with the same clinical expression.

Resolution of Hydronephrosis and Pain to Predict Stone Passage for Patients With Acute Renal Colic.

OBJECTIVE: To study patients who presented to the Emergency Department with acute renal colic to determine if resolution of hydronephrosis and pain accurately predicts stone passage on follow-up CT. MATERIALS AND METHODS: This is a secondary analysis of a multicenter prospective randomized clinical trial of patients diagnosed by computed tomography (CT) scan with a symptomatic ureteral stone < 9 mm in diameter. Participants were followed after randomization to evaluate for analgesic use and to assess stone passage and hydronephrosis on a repeat CT scan obtained at 29-36 days. RESULTS: Four-hundred-three patients were randomized in the original study and patients were included in this analysis if they did not have surgery for stone removal and had a CT scan and information on pain medication at follow-up (N = 220). Hydronephrosis was detected in 181 (82%) on initial CT. At follow-up CT, 43 (20%) participants had a persistent ureteral stone. Of these patients, 36 (84%) had no pain, 26 (60%) did not have hydronephrosis, and 23 (53%) had neither pain nor hydronephrosis. Resolution of hydronephrosis was associated with stone passage (RR 4.6, 95% CI 1.9, 11.0), while resolution of pain was not (RR 1.1, 95% CI 0.9, 1.4). CONCLUSION: In patients with urinary stone disease, stone passage is associated with resolution of hydronephrosis but not resolution of pain. In patients with persistent ureteral stones, neither pain nor hydronephrosis are consistently present. These findings have important implications on follow-up imaging of patients with urinary stone disease.

METASTATIC CHORIOCARCINOMA PRESENTING AS RENAL COLIC AND SKIN LESION - CASE REPORT.

OBJECTIVE: Choriocarcinoma is a rare malignant disease that is usually associated with a gestational event. Kidney metastasis might be misdiagnosed as renal cell carcinoma or kidney abscess. To the best of our knowledge, only 13 cases of cutaneous metastasis of choriocarcinoma have been reported in the literature so far. We report a case of choriocarcinoma that manifested with multiple metastases to the lung, skin, kidney and brain. Case report: We reported a case of a 37-year-old woman with a history of hydatiform mole, with symptoms of renal colic and abnormal findings on the skin. Chest X-ray revealed visible focal change 80 mm in diameter, located in the left lung area. The CT exposed in both kidneys multiple hypodense foci, 32 mm in size, suggesting multifocal abscesses with disruptions and perforation to paranephric area. Due to the presence of and temporary loss of vision in the right eye head CT was performed revealing metastatic changes in the brain. The diferential diagnosis between renal cancer, lung carcinoma and choriocarcinoma was achieved only after surgical removal skin lesion. This was the first time in our experience with choriocarcinoma. Immunohistochemically, the analysis was positive for beta hCG, cytokeratin AE1/AE, CK 8/18, CD10, EMA, alfa 1-inhibin and negative for protein 63, CD30 and CD117. Serum hCG level was 394590,0 mIU/mL. CONCLUSION: Conclusions: Choriocarcinoma should be taken into consideration when associated symptoms and significantly elevated blood levels of ß-hCG were identified.

The Impact of Dietary Modifications and Medical Management on 24-Hour Urinary Metabolic Profiles and the Status of Renal Stone Disease in Recurrent Stone Formers.

BACKGROUND: Dietary modifications and patient-tailored medical management are significant in controlling renal stone disease. Nevertheless, the literature regarding effectiveness is sparse. OBJECTIVES: To explore the impact of dietary modifications and medical management on 24-hour urinary metabolic profiles (UMP) and renal stone status in recurrent kidney stone formers. METHODS: We reviewed our prospective registry database of patients treated for nephrolithiasis. Data included age, sex, 24-hour UMP, and stone burden before treatment. Under individual treatment, patients were followed at 6-8 month intervals with repeat 24-hour UMP and radiographic images. Nephrolithiasis-related events (e.g., surgery, renal colic) were also recorded. We included patients with established long-term follow-up prior to the initiation of designated treatment, comparing individual nephrolithiasis status before and after treatment initiation. RESULTS: Inclusion criteria were met by 44 patients. Median age at treatment start was 60.5 (50.2-70.2) years. Male:Female ratio was 3.9:1. Median follow-up was 10 (6-25) years and 5 (3-6) years before and after initiation of medical and dietary treatment, respectively. Metabolic abnormalities detected included: hypocitraturia (95.5%), low urine volume (56.8%), hypercalciuria (45.5%), hyperoxaluria (40.9%), and hyperuricosuria (13.6%). Repeat 24-hour UMP under appropriate diet and medical treatment revealed a progressive increase in citrate levels compared to baseline and significantly decreased calcium levels (P = 0.001 and 0.03, respectively). A significant decrease was observed in stone burden (P = 0.001) and overall nephrolithiasis-related events. CONCLUSIONS: Dietary modifications and medical management significantly aid in correcting urinary metabolic abnormalities. Consequently, reduced nehprolithiasis-related events and better stone burden control is expected.

Opiates prescribed for acute renal colic are associated with prolonged use.

PURPOSE: Patients presenting with acute renal colic may be at risk of opiate abuse. We sought to analyze prescribing patterns and identify risk factors associated with prolonged opiate use during episodes of acute renal colic. METHODS: Retrospective study of patients presenting with both a stone confirmed on imaging and an acute pain episode from 6/2017-2/2020. Opiate prescription data was obtained from a statewide prescribing database. Primary outcome was an opiate refill or new opiate prescription prior to resolution of the stone episode (either passage or surgery). Univariate and multivariate linear regression analysis was performed. RESULTS: A total of 271 patients met inclusion criteria. Mean age was 52 years and 48% had a history of nephrolithiasis. 180 (66%) patients filled a new opiate prescription during their acute stone episode. Thirty-eight (14%) patients had an existing opiate prescription within 3 months of their stone episode. Seventy-four (27%) patients refilled an opiate prescription prior to stone passage or surgery. Larger stone size, need for surgery, prolonged time to treatment, existing opiate prescription, new opiate prescription at presentation, and greater initial number of pills prescribed were associated with increased risk of requiring a refill prior to stone resolution. CONCLUSIONS: Patients prescribed new opiates for acute nephrolithiasis and those with an existing opioid prescription are likely to require refills before resolution of the stone episode. Larger stones that require surgery (not spontaneous passage) also increase the risk. Timely treatment of these patients and initial treatment with non-narcotics may reduce the risk of prolonged opiate use.

Risk Factors of Urinary Tract Infection After Ureteral Stenting in Patients with Renal Colic During Pregnancy.

Introduction: To investigate risk factors associated with urinary tract infection (UTI), following ureteral stenting, for patients with renal colic during pregnancy. Patients and Methods: Patients with renal colic during pregnancy who underwent ureteral stenting in The First Affiliated Hospital of Guangzhou Medical University between 2009 and 2019 were examined retrospectively. Ureteral stenting patients who had UTIs after hospital discharge and before delivery were classified as the infected group. Multivariate logistic regression analysis was used to assess the risk factors associated with UTI after ureteral stenting. Results: A total of 102 patients were enrolled into the study. Mean age was 30 years (interquartile range [IQR]: 26-33 years) and mean gestation age was 22 weeks (IQR: 18-28 weeks). UTI occurred in 21 patients (20.6%). Compared with noninfected patients, infected patients had a higher rate of positive urine culture (52.4% vs 13.6%, p = 0.000), kidney stones ≥10 mm (81% vs 35.8%, p = 0.000), residual stones after ureteral stenting (71.4% vs 43.2%, p = 0.021), and different surgical indications and gestational ages (18 vs 23 weeks, p = 0.00). Multifactor analysis showed that gestational age, positive urine culture (odds ratio [OR] = 6.233, 95% confidence interval [CI]: 1.830-21.227), and stones ≥10 mm (OR = 0.124, 95% CI: 0.031-0.495) were independent risk factors for UTI after ureteral stenting in patients with renal colic. In the infection group, Escherichia coli was the most commonly found organism (47.4%). Conclusions: Gestational age, positive urine culture before surgery, and stone ≥10 mm were risk factors for UTI after ureteral stenting in pregnant patients with renal colic. E. coli was the main pathogen of UTI after this procedure. Preoperative anti-infection treatment needs to be based on drugs that are sensitive to E. coli.

Derivation of a clinical predicting rule for obstructive urolithiasis and alternative diagnosis requiring urgent intervention: the CLAD score.

Most patients with renal colic are discharged from the emergency department (ED) after evaluation and pain alleviation. These patients may not require urgent imaging by computed tomography. We derived a clinical prediction score in patients with renal colic to identify those at very low risk for complications and alternative diagnoses requiring urgent intervention. This retrospective chart review was carried out in 2 ED at an urban university hospital from January to December 2015. All patients with a diagnosis of renal colic were included. The primary outcome was an intervention required for renal colic or alternative diagnoses within 7 days of ED presentation. A stepwise logistic regression was used to assess factors associated with the outcome. A score was derived as a weighted sum of these predictors and its performance was calculated. The database was submitted to the French National Commission for Data Protection and Liberties (CNIL): declaration n°2164898v0 (03/22/2018). 871 with complete data were analyzed. In 94 (11%) patients, an intervention was performed for obstructive urolithiasis or alternative diagnosis. Five factors were most predictive of intervention: age > 45 years (1 point), a history of urologic surgery (1 point), pulse > 100 bpm (1 point), temperature > 37.8 °C (2 point), and urine dipstick negative for blood (1 point), yielding a score of 0-6 points (the Complicated uroLithiasis and Alternative Diagnosis (CLAD) score). The area under the curve of the receiver operating characteristic curve was 0.82 (95% CI 0.77-0.87). We derived a clinical score for renal colic that predicted the presence of obstructive urolithiasis and acute alternative diagnoses requiring intervention.

Impacts of the COVID-19 outbreak on visits and treatments for patients with ureteral stones in a general hospital emergency department.

BACKGROUND: The COVID-19 is a challenge for both patients and physicians in emergency department (ED). This study was aimed to report the impacts of the COVID-19 outbreak on visits and treatments for patients with ureteral stones in a general hospital ED. METHODS: The patients with ureteral stones were collected from 24 January to 24 March 2020 during the COVID-19 outbreak in Beijing. Two periods were divided for study: 24 January to 24 February (Period 1) and 25 February to 24 March (Period 2). Data on patients' characteristics, attendance, visual analog scale (VAS) scores, stone features, and final treatment choices were retrieved from the computer and compared with the data in the same periods in 2019. RESULTS: The study included 376 patients with ureteral stones during the COVID-19 outbreak periods in 2020 and 343 patients during the same periods in 2019. Compared with the same periods in 2019, the number of patients with ureteral stones was less in Period 1 (137 vs 163) but had a rebound phenomenon in Period 2 (239 vs 180). The visit frequency was significantly reduced (2.6 ± 0.4 vs 3.6 ± 0.8, p < 0.01) and the VAS scores and the onset time increased (7.7 ± 1.3 vs 5.5 ± 1.6, p < 0.01; 7.4 ± 1.8 vs 8.2 ± 1.5, p < 0.01, respectively) in Period 1. More patients chose oral analgesics medication to release from renal colic in the COVID-19 outbreak period instead of ESWL and intravenous analgesics medication (Period 1, 54.0% vs 20.2%, p < 0.01; Period 2, 20.9% vs 13.3%, p = 0.044; respectively). However, the percentage of patients underwent endoscopy surgery in outbreak period showed no significant difference compared with that in 2019. CONCLUSION: These results showed that the COVID-19 outbreak can directly affect the visits and final treatment choices for patients with ureteral stones.

Ruptured functioning adrenal tumour, atypical presentation with renal colic and hypertension.

Pheochromocytomas are uncommon tumours that originate in chromaffin cells. They are a representation of 0.1%-1% of all cases of secondary hypertension. Most pheochromocytomas are unilateral and benign, featuring catecholamine production, as well as the production of other neuropeptides. Pheochromocytomas are mostly located in the adrenal gland; the frequency of occurrence is highest between 30 and 50 years of age; however, up to 25% of cases may be linked to multiple endocrine neoplasia type 2, Von-Hippel-Landau disease and type 1 neurofibromatosis in the young.We present a case of ruptured left adrenal pheochromocytoma with an atypical presentation. A 30-year-old male patient presented with severe left flank pain and hypertension. The CT scan of the abdomen showed bleeding from the left adrenal mass, where resuscitation and angioembolisation were done. Embolisation of the inferior and superior arteries was done, but the middle failed. The patient experienced a significant drop in haemoglobin and a haemorrhagic shock post angioembolisation, which called for emergency laparotomy. The patient is currently doing well with an uneventful postoperative course.

Early Surgical Intervention for Symptomatic Renal and Ureteral Stones is Associated With Reduced Narcotic Requirement Relative to Trial of Passage.

OBJECTIVES: To evaluate if trial of passage (TOP) or initial surgical intervention resulted in less narcotic analgesia utilization in patients with acute renal colic due to stone disease. METHODS: We retrospectively evaluated 135 patients with acute renal colic due to nephroureterolithiasis managed by a single surgeon. Patients were standardly offered TOP or surgical intervention with ureteroscopy (URS). A subset of patients were stented with delayed URS due to presence of infection, pain, or a nonaccommodating ureter. Our standard practice is narcotic-free URS, prescribing a stent cocktail including non-steroidal anti-inflammatories. We compared rates of narcotic prescription over the entire treatment course for patients electing TOP vs surgery (primary or delayed URS). We secondarily analyzed rates of surgical intervention among initial TOP. RESULTS: We included 135 patients, with 69 (51.1%) TOP as initial treatment, 39 (28.9%) stent with delayed URS, and 27 (20.0%) primary URS. Thirty-nine (56.5%) TOP patients underwent URS at a median time of 18 days (IQR 6-31 days) from diagnosis. More TOP patients required a narcotic prescription (60.9% vs 35.9% vs 33.3%, respectively; P = .010) compared to patients undergoing initial stent or URS. However, when an opioid prescription was provided, the total morphine milligram equivalents prescribed among each group was not statistically significant. CONCLUSION: Patients electing initial treatment with TOP for renal colic due to stone disease were more likely to require narcotic prescriptions than patients electing initial surgical intervention.

Pregnancy and Delivery in Women with Lower Urinary Tract Reconstruction: A National Multicenter Retrospective Study from the French-Speaking Neuro-Urology Study Group (GENULF) and the Neuro-Urology Committee of the French Association of Urology.

PURPOSE: Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population. MATERIALS AND METHODS: We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively. RESULTS: Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence. CONCLUSIONS: In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.