Subcapsular hematoma after ureteroscopy and laser lithotripsy.

Subcapsular hematoma is an uncommon complication after ureteroscopy and laser lithotripsy. We report on a 38-year-old male with an 8 mm lower pole stone who underwent a left ureteroscopy and laser lithotripsy. The stone was successfully fragmented. Several hours after being discharged home, the patient returned complaining of back pain and hematuria. He was hemodynamically stable. Laboratory exams were normal. A CT study showed a crescent renal subcapsular hematoma surrounding the left kidney. The patient was admitted to the ward for conservative treatment. No additional intervention was necessary. Most subcapsular hematomas tend to resolve spontaneously.

[Subcutaneous ureteral bypass devices as a treatment option for bilateral ureteral obstruction in a cat with ureterolithiasis]. / Beidseitiger Einsatz eines subkutanen Ureter-Bypass bei einer Katze mit bilateraler Harnleiterobstruktion.

A 6-year-old female spayed Domestic Shorthair cat was presented with acute lethargy, dehydration, marked azotemia, metabolic acidosis, left-sided renomegaly, and bilateral hydronephrosis. Ureterolithiasis and ureteral obstruction were suspected based on further diagnostics including abdominal sonography. Medical treatment was not successful. Fluoroscopically guided antegrade pyelography confirmed the diagnosis of bilateral ureteral obstruction due to ureterolithiasis. Subcutaneous ureteral bypass (SUB) devices were placed bilaterally, followed by close patient monitoring. Frequent reassessment of patient parameters and blood work served to adjust the fluid needs of the patient and to ensure proper hydration, correction of azotemia at an appropriate rate, and cardiovascular stability. After significant improvement of all patient parameters within 5 days, the patient was discharged from the hospital. Treatment included a dietary change to reduce the risk of stone formation as well as a phosphorus binder. Clinical and clinicopathologic parameters were unchanged at the 1- and 4- and 7-month rechecks (consistent with IRIS CKD stage II-NP-AP0), and both SUB devices continued to provide unobstructed urine flow. Bilateral placement of subcutaneous ureteral bypass devices may be a safe and potentially effective treatment option for acute bilateral ureteral obstruction in cats with ureterolithiasis. Strict patient monitoring and patient-centered postoperative treatment decisions are crucial to successful treatment outcomes.

Tratamiento médico expulsivo de la litiasis ureteral con bloqueadores adrenérgicos alfa / Expulsive medical treatment of ureteral stone with adrenergic alfa-blockers

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Staphylococcus saprophyticus bacteremia after ESWL in an immunocompetent woman.

Staphylococcus saprophyticus is a well-known cause of uncomplicated urinary tract infections, especially in young and sexually active women. Presence in blood cultures is rare and often attributed to contamination. When bacteremia is significant, it occurs mostly in patients with hematologic malignancies and is predominantly catheter-related. However, we describe a case of significant bacteremia with S. saprophyticus associated with urinary tract infection after extracorporeal shock wave lithotripsy of an ureterolithiasis in an otherwise healthy patient.

Estudio prospectivo que compara la litotricia extracorpórea y la ureteroscopia en el tratamiento de la litiasis de uréter distal / Prospective trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi

Objetivos: Comparar los resultados en el manejo de la litiasis de uréter distal entre la litotricia extracorpórea (LEC) y ureteroscopia (URS) y así evaluar la mejor alternativa de tratamiento en esta afección. Material y métodos: Un total de 104 pacientes con diagnóstico de litiasis de uréter distal, que requerían tratamiento quirúrgico. Se realizó un enrolamiento y seguimiento prospectivo. Se utilizó en LEC un litotriptor Modulix SLX Storz, en la URS se utilizó un ureteroscopio semirrígido Storz 33 cm, diámetro de 7,5 a 9,5 Fr, óptica 6º. Del total de pacientes, 54 fueron a LEC y 50 a URS, y 62 eran varones y 42, mujeres, con una edad promedio de 49,72 años para LEC y de 52,16 años para URS. En la LEC el promedio de tamaño fue 8,29 mm y en la URS, de 8,96 mm. Se estableció una significación estadística p <0,05. Resultados: El tiempo del procedimiento para la LEC, separado por sexo, fue de 55 min en el caso de los varones y de 45 min en las mujeres. Para la URS fue de 80 min para los varones y de 55 min para las mujeres. El tiempo de hospitalización promedio para la LEC fue de 4,8h (todos los procedimientos ambulatorios). En el caso de la URS, fue de 22 h. Las complicaciones en el caso de la LEC fueron del 7% y para la URS, del 7,9%. De los pacientes tratados por LEC, el 74,3% presentó stone free a los 30 días, a diferencia de la URS, que presentó un porcentaje de stone free del 92,3% (p < 0,05).Conclusiones: Basados en los resultados de este estudio, la URS es el método más adecuado para el manejo de la litiasis de uréter distal, tanto en resultados de stone free como en la falta de significación en la comparación de complicaciones (AU)

Purpose: To compare the efficacy of ureteroscopy and extracorporeal shock wave lithotripsy (ESWL) in treating distal ureteral calculi and evaluate the best treatment alternative for this disease. Material and methods: A total of 104 patients with distal ureteral calculi requiring surgical intervention were enrolled and observed in a prospective follow-up. For ESWL, a Modulix SLX Storz lithotriptor was used and for ureteroscopy, a Storz 33 cm semi-rigid ureteroscope with a diameter of 7,5 to 9,5 french and a 6-degree optic. Out of the patient total, 54 patients underwent ESWL and 50 underwent ureteroscopy. 62 patients were men and 42 women; mean age in the ESWL group was 49.72, and in the ureteroscopy group,52,16. Mean calculus size for ESWL was 8.29mm and 8,96 mm for ureteroscopy. A P<0.05 was considered statistically significant. Results: Mean procedure time for ESWL was 55 minutes in men and 45 minutes in women. For ureteroscopy, procedure time was 80 minutes for men and 55 minutes for women. For ESWL, the mean hospital stay was 4.8 hours (same-day discharge for all patients). Mean hospital stay for ureteroscopy patients was 22 hours. 7% of ESWL patients experienced complications compared with 7.9% of those undergoing ureteroscopy. At the 30-day follow up, 74.3% of ESWL patients were stone free, while 92,3% of the ureteroscopy patients were stone free (P<0.05). Conclusions: Based on the results of this study, ureteroscopy is a better method for treating distal ureteral calculi because of its stone free rates and because the difference in complication rates was not significant (AU)

Is routine ureteral stenting necessary after uncomplicated ureteroscopic lithotripsy for lower ureteral stones larger than 1 cm?

We evaluated the need for routine ureteral stenting after uncomplicated ureteroscopic lithotripsy (URSL) without dilation for lower ureteral stones larger than 1 cm. A total of 43 patients underwent URSL for lower ureteral stones larger than 10 mm. They were randomized into a stented (21) or an unstented (22) group. URSL was performed by using a semirigid ureteroscope and pneumatic lithotripter without ureteral dilation. Additional forceps application (AFA) was used to remove fragments > or =4 mm. Patients in each group were assessed for stone-free rate, stone size, operative time, AFA, hospitalization time, postoperative pain, irritative voiding symptoms, hematuria, re-hospitalization and stricture formation. The stone-free rate was 100% in each group. There were no statistical differences in the two groups regarding stone size, operative time, AFA, postoperative pain, hematuria and hospitalization time. However, irritative voiding symptoms of the stented group were significantly higher than those in the unstented group (P < 0.05). One patient (4.5%) in the unstented group required re-hospitalization for severe flank pain with fever (>38 degrees C) compared to one patient (4.7%) in the stented group for proximal stent migration (P > 0.05). Stricture formation was not demonstrated in either group at 3 months follow-up excretory urography (EXU). Our results demonstrate that ureteral stenting after uncomplicated URSL without dilation for lower ureteral stones larger than 1 cm does not appear to be necessary if AFA is used to remove fragments > or =4 mm, thereby reducing morbidity of patients and risk of re-hospitalization.