Non-invasive evaluation of obstruction after ureteroscopic stone removal: Role of renal resistive index assessment

Eryıldırım, Bilal; Şahan, Ahmet; Turkoglu, Ozlem; Tuncer, Murat; Kavukoğlu, Övünç; Simsek, Berkan; Çubuk, Alkan; Sarıca, Kemal

doi:10.4081/aiua.2020.3.244

Cited by 3 publications

(6 citation statements)

References 20 publications

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“…Urolithiasis is the communal and oldest diseases of the urinary system. Currently, ureteroscopy is one of the most common procedures among various endourological operations and is performed for a variety of indications, including fragmentation and removal of ureteroscopic stones [12][13] . In 2002, Hoskin et al determined that routine stenting of ureter is unnecessary after uncomplicated ureteroscopic removal of the distal ureteral stone, and the same observation was observed in our study [14][15] .…”

Section: Discussionmentioning

confidence: 99%

Study to Determine the Requirement of Ureteral Stent after Uncomplicated Ureteroscopy for Ureteric Stones

Ahmad¹,

Farhan²,

Rehman³

et al. 2022

PJMHS

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Aim: The purpose of the study is to determine the necessity of using a ureteral stent later to uncomplicated ureteroscopy in ureteral stones with intracorporeal lithotripsy. Methods: For ureteric stones 170 cases were planned for ureteroscopic lithotripsy at the Urology Department of Sahiwal Teaching hospital, Sahiwal and Abbasi Shaheed Hospital, Karachi for two-years duration from July 2019 to June 2021. 170 patients were encompassed in the analysis after stones fragmentation. The patients were divided randomly into 2 groups: the 1st group (80 patients with a stent) was inserted postoperatively with ureteral stents, while the second group had no stent (90 patients without a stent). Two weeks apart; stents were removed. Each group patients were evaluated for duration of surgery, success, postoperative pain, voiding irritating symptoms, stricture formation and hematuria. Results: Both groups of patients were similar in relation of sex, age and mean size of stones. The mean surgery duration was 40 minutes (15-55) in the stent group and 35 mints (20-45) for the stent-less group. Irritation symptoms during urination were observed in 33.7% in the group with stents and 26.7% in the group without the stent. 23(28.7%) patients in the group placed with stents and 13(14.4%) in the stentless group required two or more analgesics per day immediately after surgery. One patient in the stentless group required re-hospitalization for pain control. Hematuria developed in 11 patients (13.7%) and 9 patients (10%) in the stented and non-stented groups, correspondingly. The stricture formation and stone-free rate did not differ amongst the both groups. Conclusion: Ureteral stenting is not essential after uncomplicated ureteroscopy in the ureteral stone’s treatment with intracorporeal shock wave lithotripsy. While placing the stent in the ureter does not provide any additional benefit, it is inconvenient for the patient in terms of cost and subsequent recovery. Keywords: Ureteral stent, Ureteroscopy, Ureteral calculus.

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Section: Discussionmentioning

confidence: 99%

Study to Determine the Requirement of Ureteral Stent after Uncomplicated Ureteroscopy for Ureteric Stones

Ahmad¹,

Farhan²,

Rehman³

et al. 2022

PJMHS

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“…Prolongation of the acceleration phase and flattening of the flow spectrum curve in patients with renal arterial stenosis are observed in Doppler examinations ( 10 ) . It has been already proven that reduced perfusion due to obstruction of urine outflow from the pelvicalyceal system increases the peripheral resistance in the vascular bed of the kidney, which is reflected in an increase in the resistive index (RI), while the acceleration phase remains normal ( 11 , 12 ) . Doppler exam complements the information obtained from the CEUS enhancement curve analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Contrast-enhanced ultrasonography is a recognized method for the assessment of kidney lesions and perfusion disorders resulting from impaired patency of the renal vessels (2)(3)(4)(10)(11)(12) . Modern ultrasonography contrast agents persist in the vessels, without interstitial diffusion and glomerular filtration.…”

Section: Fig 3 3d Reconstruction Of the Ct Image Of The Abdominal Cav...mentioning

confidence: 99%

Is contrast-enhanced ultrasonography (CEUS) useful in the assessment of obstructive uropathy-induced perfusion disorders?

et al. 2021

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Aim: The study aimed to evaluate the usefulness of contrast-enhanced ultrasonography in renal perfusion disorders caused by obstructive uropathy. Case description: We present a case of a patient with a horseshoe kidney, in which the urine outflow from the right part of the kidney was blocked due to the presence of a bladder tumour infiltrating the ureter. Perfusion disorders in both parts of the kidney, visible in computed tomography, were partially reflected in the ultrasound image. Conclusions: Doppler ultrasound and contrast-enhanced ultrasound may be useful for monitoring perfusion disorders in the course of obstructive uropathy, provided that appropriate methodology is developed to compare blood flow in both kidneys.

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“…Published data demonstrated that NGAL could also be used as one of the most reliable markers in the assessment of kidney injury after ischemic or nephrotoxic states among which urinary obstruction is the most common (16). Lastly, Doppler sonographic evaluation of the vascular impedance in the renal parenchyma was used be to evaluate the functional or structural changes induced by acute and chronic obstructive renal diseases (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

“…It was used as an early, sensitive biomarker for (14)(15)(16). Lastly, by providing information about the changes in microvascular blood flow, renal parenchymal doppler sonographic evaluation of the vascular impedance renal resistivity index (RRI) may be helpful in the asssessment of the functional or structural changes caused by acute and chronic obstructive renal diseases (17)(18)(19). We aimed to evaluate the time dependant functional and morphological recovery of obstructed kidneys after JJ stenting in cases with impacted ureteral stones.…”

Section: Introductionmentioning

confidence: 99%

Time dependant functional and morphological recovery of the kidney after relief of obstruction in patients with impacted ureteral stones

Kocatürk

Bedir

Turangezli

et al. 2021

Arch Ital Urol Androl

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Objectives: To assess the course of functional and morphological recovery of the kidney following the relief of obstruction with ureteral JJ stent in cases with unilateral impacted stones. Materials and methods: A total of 42 adult patients who were admitted to our clinic with unilateral obstructing impacted ureteral stones requiring JJ stent placement were included in the study. The course of functional recovery was assessed by evaluating the serum creatinine levels, renal resistive index (RRI) values and urinary levels of kidney injury molecule-1, neutrophil gelatinaseassociated lipocalin as well as microalbumin before at 1 day, 1 week and 4 weeks after JJ stent placement. Course of morphologic recovery was evaluated by evaluating the degree of hydronephrosis, kidney size, perirenal straining and ureteral diameter. Results: Our results showed that all relevant parameters began to decrease after 24 hours and continue to normalize during 1 week evaluation; majority of these variables indicating the functional and morphological recovery were in normal range after 4 weeks. Decompression of the obstructed kidneys with JJ stent placement in patients with impacted ureteral stones was found to be effective enough with recovery of normal renal functional and morphological status after a minimum time period of 4 weeks. Morphological recovery of affected kidneys following JJ stenting was obtained with a significant difference between baseline and 1-month evaluation findings (p = 0.001, p < 001, p < 001, respectively). KIM-1 excretion began to decline to normal levels after 4 weeks (3.52 ± 0.99 ng/ml versus 2.84 ± 0.66 ng/ml, p < 0.001). The same findings were observed for the urinary excretion levels of NGAL, which normalized at the 1-month evaluation (604.55 ± 140.28 ng/ml versus 596.87 ± 80.17 ng/ml p = 0.895). Urinary microalbumin excretion levels however remained high even until 1-month follow-up with a statistically significant difference when compared with the normal excretion values (p < 0.001). There was a statistically significant difference in RRI values between baseline and 1-month follow-up findings in obstructed kidney (p < 0.001). Conclusions: Elective management of the obstructing impacted ureteral stone(s) will be safer with limited risk of infective complications after functional and morphological normalization in such kidneys following 4 weeks of JJ stent placement.

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Non-invasive evaluation of obstruction after ureteroscopic stone removal: Role of renal resistive index assessment

Cited by 3 publications

References 20 publications

Study to Determine the Requirement of Ureteral Stent after Uncomplicated Ureteroscopy for Ureteric Stones

Study to Determine the Requirement of Ureteral Stent after Uncomplicated Ureteroscopy for Ureteric Stones

Is contrast-enhanced ultrasonography (CEUS) useful in the assessment of obstructive uropathy-induced perfusion disorders?

Time dependant functional and morphological recovery of the kidney after relief of obstruction in patients with impacted ureteral stones

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