Predicting the Impacted Ureteral Stone with Computed Tomography

Tran, Tim; Bamberger, Jacob; Blum, Kyle A.; Parkhomenko, Egor; Thai, Julie; Chandhoke, Ryan; Gupta, Mantu

doi:10.1016/j.urology.2019.04.020

Cited by 24 publications

(15 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Not only stone parameters but also ureteral characteristics on imaging should be considered in the decision to proceed with URS versus PCN. We have identified stone impaction as an additional parameter that predicts clinical outcome [15,16,20]. Stone impaction can be explained by pathological changes in the ureteral wall, such as edema and hypertrophy at the site of the stone [21].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have highlighted the predictors for stone impaction during URS and determined preoperative radiological parameters such as increased ureteral wall thickness and ureteral wall density at the stone level to be predictors for stone impaction [15,16,23]. Higher PUD below the stone level has been considered to be another co-factor responsible for URS failure as it may represent more ureteral inflammation and spasm precluding passage of the ureteroscope to reach stones [15,16]. Other studies have found the severity of hydronephrosis and increased serum creatinine to be associated with impacted ureteral stones during URS [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Also, maximum transverse stone diameter in mm was calculated on axial images (Figure 1). Periureteral density (PUD) in HU was measured below the stone level and at the stone level at its maximum transverse diameter [15]. The pericalcular ureteric thickness (P-CUT) was measured as the widest transverse measurement of the ureter involving the stone and the corresponding maximum transverse diameter of the stone at this level.…”

Section: Radiological Measurements For P-cut and Pud At And Below The Stone Levelmentioning

confidence: 99%

See 2 more Smart Citations

Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy

Elbaset¹,

Edwan²,

Abouelkheir³

et al. 2021

Société Internationale D’Urologie Journal

View full text Add to dashboard Cite

Objective: To define predictors for initial retrograde ureteral stenting (RUS) failure with the need for the percutaneous nephrostomy (PCN) insertion as a drainage method in patients with complicated acute calculus obstructive uropathy. Methods: We undertook a retrospective evaluation of patients who presented with complicated obstructive calculus uropathy (acute renal failure or obstructive pyelonephritis) between January 2016 and January 2020. Patients in whom there was failure to visualize ipsilateral ureteric orifice and those with extrinsic ureteral obstruction were excluded. Patient demographics and radiological data including stone site, hydronephrosis grade, maximum transverse stone diameter, periureteral density (PUD) and pericalcular ureteric thickness (P-CUT) at the maximum transverse stone diameter were assessed using non-contrast computed tomography at the time of admission. Results: The study included 256 patients who were managed initially by RUS trial. Of them, 48 (18.8 %) had RUS failure. The presence of acute pyelonephritis, increased maximum transverse stone diameter ≥ 9.5 mm, P-CUT ≥ 7.5 mm, and PUD at stone level ≥ 17.5 HU were risk factors associated with RUS failure (P = 0.007, 0.002, < 0.001, and < 0.001, respectively). Conclusion: Initial radiological stone and ureteric characteristics, in addition to the clinical diagnosis of obstructive pyelonephritis, can be used to determine PCN insertion as the preferred option over RUS for urinary drainage.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Radiological Measurements For P-cut and Pud At And Below The Stone Levelmentioning

confidence: 99%

See 1 more Smart Citation

Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy

Elbaset¹,

Edwan²,

Abouelkheir³

et al. 2021

Société Internationale D’Urologie Journal

View full text Add to dashboard Cite

show abstract

“…Tran et al recently evaluated the possible role of proximal and distal ureter HU on CT to predict stone impaction with promising results. To avoid possible biases on the definition, we decided not to evaluate this aspect in the present study; however, a study on the subject is ongoing and preliminary results have been published recently in an abstract [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Development of a nomogram predicting the probability of stone free rate in patients with ureteral stones eligible for semi-rigid primary laser uretero-litothripsy

et al. 2021

View full text Add to dashboard Cite

Purpose Few tools are available to predict uretero-lithotripsy outcomes in patients with ureteral stones. Aim of our study was to develop a nomogram predicting the probability of stone free rate in patients undergoing semi-rigid uretero-lithotripsy (ULT) for ureteral stones. Methods From January 2014 onwards, patients undergoing semi-rigid Ho: YAG laser uretero-lithotripsy for ureteral stones were prospectively enrolled in two centers. Patients were preoperatively evaluated with accurate clinical history, urinalysis and renal function. Non-contrast CT was used to define number, location and length of the stones and eventually the presence of hydronephrosis. A nomogram was generated based on the logistic regression model used to predict ULT success. Results Overall, 356 patients with mean age of 54 years (IQR 44/65) were enrolled. 285/356 (80%) patients were stone free at 1 month. On multivariate analysis single stone (OR 1.93, 95% CI 1.05–3.53, p = 0.034), stone size (OR 0.92, 95% CI 0.87–0.97, p = 0.005), distal position (OR 2.12, 95% CI 1.29–3.48, p = 0.003) and the absence of hydronephrosis (OR 2.02, 95% CI 1.08–3.78, p = 0.029) were predictors of success and these were used to develop a nomogram. The nomogram based on the model presented good discrimination (area under the curve [AUC]: 0.75), good calibration (Hosmer–Lemeshow test, p > 0.5) and a net benefit in the range of probabilities between 15 and 65%. Internal validation resulted in an AUC of 0.74. Conclusions The implementation of our nomogram could better council patients before treatment and could be used to identify patients at risk of failure. External validation is warranted before its clinical implementation.

show abstract

“…Impacted proximal ureteral stones usually refer to the stones that remain in the same location of the upper ureter for more than 2 months. [ 1 , 2 ] The stone can adhere to the ureteral wall and prevent the passage of the guidewire. This condition is often complicated by hydronephrosis, infection, and pathological lesions, such as ureteral polyps at the stone site.…”

Section: Introductionmentioning

confidence: 99%

Comparison of mini-percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy for treatment of impacted proximal ureteral stones greater than 15 mm

Wang¹,

Huang²,

Zhao³

et al. 2021

Chinese Medical Journal

View full text Add to dashboard Cite

Background: The optimal treatment for large impacted proximal ureteral stones remains controversial. The aim of this study was to evaluate the efficacy, safety, and potential complications of mini-percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic ureterolithotomy (RPLU) in the treatment of impacted proximal ureteral stones with size greater than 15 mm. Methods: A total of 268 patients with impacted proximal ureteral stones greater than 15 mm who received MPCNL or RPLU procedures were enrolled consecutively between January 2014 and January 2019. Data on surgical outcomes and complications were collected and analyzed. Results: Demographic and ureteral stone characteristics found between these two groups were not significantly different. The surgical success rate (139/142, 97.9% vs. 121/126, 96.0%, P = 0.595) and stone-free rate after 1 month (139/142, 97.9% vs. 119/126, 94.4%, P = 0.245) of RPLU group were marginally higher than that of the MPCNL group, but there was no significant difference. There was no significant difference in the drop of hemoglobin between the two groups (0.8 ± 0.6 vs. 0.4 ± 0. 2 g/dL, P = 0.621). The mean operative time (68.2 ± 12.5 vs. 87.2 ± 16.8 min, P = 0.041), post-operative analgesics usage (2/121, 1.7% vs. 13/139, 9.4%, P = 0.017), length of hospital stay after surgery (2.2 ± 0.6 vs. 4.8 ± 0.9 days, P < 0.001), double J stent time (3.2 ± 0.5 vs . 3.9 ± 0.8 days, P = 0.027), time of catheterization (1.1 ± 0.3 vs. 3.5 ± 0.5 days, P < 0.001), and time of drainage tube (2.3 ± 0.3 vs . 4.6 ± 0.6 days, P < 0.001) of MPCNL group were significantly shorter than that of the RPLU group. The complication rate was similar between the two groups (20/121, 16.5% vs . 31/139, 22.3%, P = 0.242). Conclusions: MPCNL and RPLU have similar surgical success and stone clearance in treating impacted proximal ureteral stones greater than 15 mm, while patients undergoing MPCNL had a lower post-operative pain rate and a faster recovery.

show abstract

Predicting the Impacted Ureteral Stone with Computed Tomography

Cited by 24 publications

References 16 publications

Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy

Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy

Development of a nomogram predicting the probability of stone free rate in patients with ureteral stones eligible for semi-rigid primary laser uretero-litothripsy

Comparison of mini-percutaneous nephrolithotomy and retroperitoneal laparoscopic ureterolithotomy for treatment of impacted proximal ureteral stones greater than 15 mm

Contact Info

Product

Resources

About