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Laser lithotripsy has become an effective and low-morbidity procedure for the treatment of ureteral calculi. Nevertheless, ureteral endoscopy is not free of side effects and complications. Lithiasis extrusion is one of the early complications of this procedure, and usually, the diagnosis is carried out by means of urographic findings because it is not easily recognized during ureteroscopy. Between January 1990 and May 1996, a total of 1047 endoscopic lithotripsies with the pulsed-dye laser were performed in our department. The 3-month stone-free rate as a single treatment was 76.5%. We found 11 cases (1.05%) of calculi extrusion after ureteral endoscopic treatment. Only one case was diagnosed intraoperatively. The evolution after a mean follow-up period of 18 months (range 6-34 months) was satisfactory in all cases. No urinary extravasation, infection, or secondary ureteral strictures were found. According to the absence of side effects, it was considered unnecessary to remove the extruded calculi. Extrusion of noninfected calculi into the periureteral tissues after laser lithotripsy causes no significant consequences and can be successfully managed conservatively. Knowledge of this possible complication is the best way to avoid it. A careful technique and a low irrigant flow will be very helpful.

Introduction:The aim of the study is to compare clinical staging of anterior pelvic prolapse with magnetic resonance imaging (MRI) staging, using the pubococcygeal line (PCL), the midpubic line (MPL), and the H line as reference lines. Moreover, we aim to analyze interrater reliability of each reference line.Material and Methods: Forty-two women with pelvic organ prolapse (POP) symptoms were studied using the pelvic organ prolapse quantification on physical examination. Two different observers calculated anterior POP using the three MRI reference lines, retrospectively. Agreement between MRI and clinical staging was estimated using Pearson correlation for the quantitative measurements and kappa index for the stages. Interrater reliability was estimated using the intraclass correlation coefficient (ICC).Results: Correlation between physical examination and the H line was high by both observers (r = 0.86 and r = 0.76, p < 0.01). The correlation was lower using MPL (r = 0.76 and r = 0.65, p < 0.01). The results of comparing MRI staging and physical examination were: κ = 0.618 and κ = 0.602 for the H line, κ = 0.273 and κ = 0.267 for MPL and κ = −0.105 and κ = −0.140 for PCL. The results of interrater reliability were: ICC of 0.968 for the H line, ICC of 0.788 for MPL, and ICC of 0.737 for PCL. Conclusion:Anterior POP staging using MRI H line as a reference presents a better agreement with clinical staging than PCL or MPL. The H line has better interrater reliability. The H line could replace the current lines.

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Some of the assessed indicators can be useful for incorporation into health information systems.