Cite as: Can Urol Assoc J 2014;8(1-2):e8-11. http://dx.doi.org/10.5489/cuaj.1261 Published online January 14, 2014. AbstractIntroduction: We evaluate the efficiency of α-adrenergic antagonists on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with lower ureteral stones. Methods: A total of 356 patients with solitary lower ureteral stones who underwent single ESWL sessions were divided into 2 groups. Group 1 received our standard medical therapy, and Group 2 was treated with 0.4 mg/day tamsulosin for a maximum of 2 weeks. All patients were re-evaluated with plain film radiography and ultrasound each week during the treatment period. A computed tomography scan was systematically performed 3 months after ESWL. Results: In total, 82 of the 170 patients in Group 1 (48.2%) and 144 of the 186 patients in Group 2 (77.4%) (p = 0.002) were stonefree. Among the patients with stones 10 to 15 mm in diameter, the stone-free rate was 38.4% in Group 1 and 77.1% in Group 2 (p = 0.003). Average stone expulsion time was 10.6 days and 8.4 days in Groups 1 and 2, respectively. Ureteral colic occurred in 40 patients (23.5%) in Group 1, but only in 10 patients (5.3%) in Group 2 (p = 0.043). The only side effect of tamsulosin was slight dizziness in 5 of the 186 patients in Group 2 (2.6%). Conclusion: Adjunctive therapy with α1-adrenergic antagonists after ESWL is more efficient than, and equally as safe as, lithotripsy alone to manage patients with lower ureteral stones. The adding of α-blockers is more reliable and helpful for stones with a large dimension, and can also decrease stone elimination time and episodes of ureteral colic.

images in clinical medicineT h e n e w e ng l a n d j o u r na l o f m e dic i n e n engl j med 366;17 nejm.org april 26, 2012 1625A 22-year-old man with a history of uncorrected left cryptorchidism presented after 7 days of left groin pain. A genitourinary examination was performed, which revealed that his left inguinal region was swollen because of a palpable, tender mass that was 5 cm in greatest dimension. No testicle was palpable in the ipsilateral hemiscrotum (Panel A). An ultrasound examination of the inguinal area revealed a heterogeneous testicle, with no blood flow on Doppler examination. Surgical exploration confirmed torsion of the undescended testis (Panel B). Torsion of a cryptorchid testicle is an uncommon condition but is reported to occur more frequently than torsion of a normally descended testis. In a patient presenting with pain and uncorrected cryptorchidism, a testicular tumor must also be considered in the differential diagnosis. In this patient, final pathological examination revealed a diffusely ischemic, necrotic testicle with no malignant tumor.

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