Characterization of ureteral lesions associated with impacted stones

Abstract

Background: Few studies have addressed the various types of ureteral lesions apparent in patients treated for ureteral stones, especially in those with impacted stones. Macroscopic and microscopic analyses of ureteral lesions associated with impacted stones were therefore undertaken. Methods: From May 1994 to October 1996, 36 patients with ureteral stones, 21 of whom showed stone impaction, were treated with transurethral ureterolithotripsy. After ureteroscopic examination, biopsied specimens were obtained from six patients with impacted stones and were examined microscopically by conventional hematoxylin and eosin staining. Results: Ureteroscopy revealed two types of mucosal lesions in the patients with impacted stones: Type 1 lesions were defined as edematous or cystic hemispheric lesions and occurred in 18 patients, whereas type 2 lesions had a villous appearance and were present in three patients. Microscopically, type 1 lesions appeared as submucosal edema without specific findings, whereas type 2 lesions appeared as columnar mesenchymal tissue coated with several layers of transitional epithelium. With regard to factors that might contribute to lesion formation, duration of stone presence was significantly greater for patients with impacted stones than for those with-nonimpacted stones. However, no differences in such parameters were apparent between patients with type 1 lesions and those with type 2 lesions. Conclusions: Two types of ureteral lesions associated with impacted stones were confirmed microscopically. The duration of stone presence is a potential contributing factor in the development of ureteral lesions, but factors that determine the type of ureteral lesion remain unclear.

C-Reactive Protein - A Reliable Predictive Parameter in Expulsion of Small Distal Ureteric Calculus

“…In our study, we reported that a significant association between spontaneous ureteric stone expulsion and serum CRP level in our study implies that inflammatory changes in the ureteric wall and that submucosal oedema in association with ureteric stone may play a role in failure of medical expulsive therapy of ureteric stone. (10) We noticed that serum CRP is significantly higher in patients who failed to expel the stone within 4 weeks than in those with spontaneous stone expulsion within 4 weeks (39.67 + 6.30 and 16.45 + 2.58 respectively, p value = 0.001). The patient's age, sex and laterality did not differ between both groups.…”

“…(8,14) It has been shown that larger calculi particularly tend to provoke intense inflammatory changes in the ureteric wall and that submucosal oedema in proximity to a stone may worsen ureteric obstruction, heightening the risk of impaction and retention. (10) According to some studies, which investigate the role of CRP as a diagnostic marker in some urological diseases (6,7) and depending on the ureteric wall inflammation induced by ureteric stones, (10) we evaluate serum CRP level in patients with ureteric stones in a trial to use CRP as a factor that assist in management of ureteric stones in addition to other factors as stone size, site and degree of hydronephrosis. In our study, we reported that a significant association between spontaneous ureteric stone expulsion and serum CRP level in our study implies that inflammatory changes in the ureteric wall and that submucosal oedema in association with ureteric stone may play a role in failure of medical expulsive therapy of ureteric stone.…”

“…It is not surprising then that CRP level may be a diagnostic tool for some urological diseases, such as for differentiating acute appendicitis from right-sided renal colic [10] and acute pyelonephritis from cystitis [11] for predicting the development of infection in patients who have undergone lithotripsy [12,13] or for diagnosing and following up urinary tract infections in children. [14] Serum CRP level is a nonspecific marker of systemic inflammation.…”

The need for additional equipment after ESWL in ureteroscopic lithotripsy

“…[5] Uzun dönemde ESWL'nin mukozaya adezyonu arttırıcı etkisinin olduğu da bilinmektedir. [9] ESWL sonrası reoperasyon gereksiniminin %5-60 olduğu göz önüne alındığında ESWL başarısızlığında en akılcı tedavi alternatifinin şüphesiz üreteroskopik litotripsi olduğu anlaşılabilir. [10][11][12][13][14] Üreteroskopik teknolojide alet çaplarının küçülmesi, çalışma kanallarının genişlemesi, aksesuar enstrümanlardaki gelişmeler, litotriptörler arasına lazer gibi oldukça minimal invazif ve etkili çözümlerin katılması üreteroskopik litotripsiyi üreter taşı tedavisinde vazgeçilmez bir alternatif haline getirmiştir.…”

Myth: Nephrolithiasis and medical expulsive therapy

“…[6][7][8]12 Corticosteroids Investigators have shown that larger stones tend to cause more intense ureteral inflammatory reactions and that submucosal edema in the vicinity of a stone may aggravate urinary obstruction and calculus retention. 13,14 Corticosteroids stabilize neutrophil lysosomes, therefore decreasing inflammation and edema related to mechanical irritation. 15 Steroids, notably deflazacort and prednisone, [4][5][6]8 can be used in conjunction with the medical expulsive therapies discussed above.…”