PURPOSE: The objective of this study were to evaluate the location of ureteral stones and the diameter of the ureter in patients with renal colic. MATERIALS AND METHODS: We retrospectively reviewed the records of 95 consecutive patients who presented to the emergency department with renal colic in whom urinary stones were diagnosed by computed tomography between January 2009 and August 2009. The size and location of the stones were investigated. The length and diameter of unaffected ureters were also measured. RESULTS: The mean size of the stones was 4.87+/-3.49 mm (range, 0.9-22 mm). Stones were located at ureterovesical junction (UVJ) in 44 cases (46.3%), proximal ureter in 29 (30.5%), distal ureter in 16 (16.8%), ureteropelvic junction (UPJ) in 5 (5.2%), and the ureter crossing external iliac vessel (UEIV) in 1 case (1%). The mean length of the ureter was 226.8+/-20.8 mm (range, 175-286 mm). The mean diameter of the ureter was 3.40+/-0.61 mm (range, 1.9-5.3 mm). The mean diameter of the UEIV was 3.28+/-0.59 mm (range, 2.2-5.3 mm). CONCLUSIONS: The UPJ and UEIV were not common sites of ureteral stones. The smaller the stones, the closer to the UVJ that the stones were located. Spontaneous passage of the stones was most frequently observed for stones in the UVJ. The UEIV was not significantly narrower than the other parts of the ureter.
Colic ; Emergencies ; Glycosaminoglycans ; Humans ; Renal Colic ; Retrospective Studies ; Ureter ; Ureteral Calculi ; Urinary Calculi

PURPOSE: The aim of this study was to evaluate the effect of tamsulosin on expulsion of ureteral stones after extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: Seventy-six patients(39 with upper ureteral stones and 37 with lower ureteral stones) treated with ESWL for stones <10mm were randomly divided into two groups. Tamsulosin(0.2mg orally once daily) was administered to group 1; group 2 received no medications. All patients were evaluated with respect to the number of episodes of ureteral colic, the expulsion rates of stones after ESWL, and the mean number of sessions of ESWL until complete expulsion of stones. RESULTS: The complete expulsion rates of upper and lower ureteral stones did not differ significantly between groups 1 and 2 during each session of ESWL; however, the mean session of ESWL was lower in group 1 than in group 2. For upper ureteral stones, 1.8 sessions were necessary per patient in group 1, while 2.3 sessions were required for the patients in group 2(p=0.039). For lower ureteral stones, 2.0 sessions were necessary per patient in group 1, while 2.9 sessions were required for the patients in group 2(p=0.032). There were significant decreases in the number of episodes of pain in group 1 with lower ureteral stones(p=0.014). There were no side effects associated with tamsulosin. CONCLUSIONS: The use of tamsulosin in the treatment of upper and lower ureteral stones after ESWL can decrease the mean number of sessions of ESWL and the number of episodes of pain, but cannot improve the expulsion rate. Further research regarding the cost-effectiveness of tamsulosin after ESWL is needed.
Calculi ; Humans ; Lithotripsy ; Renal Colic ; Shock ; Sulfonamides ; Ureter

PURPOSE: Central lucency of pelvic phleboliths is frequently observed on plain pelvic radiographs. When it is also present on noncontrast helical CT images, pelvic phleboliths may be easily diagnosed, with no suspicion of distal ureteral calculi. The objective of this study was to determine the frequency with which this phenome-non is seen on plain radiographs and noncontrast helical CT images. MATERIALS AND METHODS: During a recent two-year period we identified 70 patients with renal colic who under-went both abdomino-pelvic radiography and noncontrast helical CT scanning. Radiographs were obtained at 70 -85 kVp and 30 -40 mA; CT scans were preformed within one month of plain radiography with parameters of 120 kVp, 200 -220 mA, 5-mm collimation, and pitch of 1 -1.6, and using soft tissue and bone window settings. With regared to the central lucency of pelvic phleboliths, as seen on both on radiographs and CT im-ages, two experienced radiologists reached a consensus. RESULTS: Among the 70 patients, a total of 150 pelvic phleboliths was found. In all cases except one, pelvic radi-ography and noncontrast helical CT revealed the same number of phleboliths. The exception was a case in which one of two phleboliths demonstrated by CT was not seen on radiographs. Pelvic radiography revealed central lucency in 95 of these 150 phleboliths (63%), but noncontrast helical CT failed to depict a hypodense center in any phlebolith. CONCLUSION: Central lucency of pelvic phleboliths, as frequently seen on plain pelvic radiographs, was not revealed by routine noncontrast helical CT in any patient.The presence or absence of central lucency on these CT images cannot, therefore, be used to differentiate phleboliths from distal ureteral calculi.
Consensus ; Humans ; Radiography ; Renal Colic ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Ureteral Calculi

PURPOSE: We studied to evaluate the safety and effectiveness of the domestic SDS-3000(R) extracorporeal shock wave lithotriptor (SWL). MATERIALS AND METHODS: Between October 1995 and April 2000, 440 patients, 16 to 79 years old, were treated with the domestic SDS-3000(R) lithotriptor using C-arm fluoroscopy without regional or general anesthesia. Distribution of stones, location and size of stones, session, success rate, causes of failure and complications of SWL were retrospectively reviewed. RESULTS: Of 440 patients, renal stones were 133 (30.2%) and ureteral stones 307 (69.8%). The overall success rate (stone free rate) of SDS-3000(R) lithotriptor in 440 patients was 89.8% (81.4%) with 94.9% (91.0%) in 5-9mm, 87.2% (75.8%) in 10-19mm, 66.7% (42.8%) in 20-29mm and 57.1% (35.7%) over 30mm of stone size. The success rate was 94.9% for stones between 5-9mm in diameters and 82.6% for stones more than 10mm (p<0.05). As compaired with success rate for stones less then 20mm, stones more then 20mm had significently higher success rate (92.1% Vs 62.8%) (p<0.05). Ureter stones were more successfully treated than renal stones (93.2% Vs 82.0%) (p<0.05). Main complications of SWL were renal colic in 10.0%, steinstrasse in 4.3%, transient gross hematuria in 1.8% and fever in 1.1%. All of complications were controlled with conservative treatment. CONCLUSIONS: The domestic SDS-3000(R) lithotriptor monotherapy is considered to be a safe and efficient outpatient procedure for the initial treatment of urinary stones.
Aged ; Anesthesia, General ; Fever ; Fluoroscopy ; Hematuria ; Humans ; Outpatients ; Renal Colic ; Retrospective Studies ; Shock ; Ureter ; Urinary Calculi*

PURPOSE: To compare the efficacies and side effects of intravenous hydromorphone and pethidine in the emergency department (ED) treatment of ureteral colic. METHODS: A prospective, controlled, randomized clinical trial was conducted in a university-affiliated tertiary referral center. All adult patients who presented to the ED with severe ureteral colic were included. The patients received either 1 mg of hydromorphone (n=26) or 50 mg of pethidine (n=26) intravenously. Pain intensity was determined using a 10 cm visual analogue scale 0, 15, 30, and 120 minutes after injection. RESULTS: Dermographic characteristics and baseline pain scores of both groups were comparable (p>0.05). The pain intensity level for the hydromorphone group was lower than for the pethidine group at 15, 30, and 120 minutes. Pain relief was better with hydromorphone at 15 minutes (p<0.05). Side effects of the two groups were not statistically significant. CONCLUSION: The ureteral colic patients receiving hydromorphone achieved more pain relief. The side effects were similar for either treatment. Hydromorphone should be the preferred agent in suspected ureteral colic, when an opioid analgesic is to be used.
Adult ; Benzeneacetamides ; Emergencies ; Humans ; Hydromorphone ; Meperidine ; Piperidones ; Prospective Studies ; Renal Colic ; Tertiary Care Centers ; Ureter

PURPOSE: Our aim was to determine the efficacy of hematuria testing in suspected urinary stone disease using contrast enhanced multidetector computed tomography (MDCT) as the reference standard. METHODS: Records of all patients who presented to the emergency department with suspicion of urinary stone that undergone MDCT during a 2-year period were reviewed. The sensitivity, specificity, positive predictive value, and negative predictive value of the positive hematuria on the urinalysis for renal colic were calculated. The rates of incidence of negative hematuria were obtained. In addition, significant alternative CT findings requiring immediate or deferred treatment were classified. RESULTS: A total of 492 enhanced MDCTs were performed. Urinary stone had been identified in 414(84.1%) of the 492 patients, and 78 patients had a negative stone, including 33 (6.7%) with clinically significant alternative diagnoses in the latter group. Microscopic urinalysis had a sensitivity, specificity, positive predictive value, and negative predictive value of 89.4%, 41.1, 88.9%, and 42.1%, respectively. The combination of microscopic urinalysis and Urine Dipstick test (UDT) yielded a sensitivity, specificity, positive predictive value, and negative predictive value of 96.9%, 28.2%, 87.5%, 62.9%, respectively. The incidence of negative hematuria for microscopic urinalysis, UDT, and the combination were 10.6%, 4.4%, 3.1%, respectively. CONCLUSION: The presence or absence of blood on urinalysis alone cannot be used to reliably determine which patients actually have urinary stone. Therefore, patients presenting with an episode of clinically suspected urinary stone should undergo CT scanning because it enhances diagnostic certainty by identifying alternative significant diagnoses not suspected on clinical grounds alone.
Emergencies ; Hematuria ; Humans ; Incidence ; Multidetector Computed Tomography ; Renal Colic ; Sensitivity and Specificity ; Urinalysis ; Urinary Calculi ; Urolithiasis

During 5 years, from January 1976 to December 1980, clinical observation on management of ureteral stones was made on 169 admitted patients with ureter stones. Following results were obtained. 1) Among total 1054 in-patients, 169 cases (16.0%) had ureteral stones, and male to female ratio was 2 : 1. 2) Patients with 20-40 of his age was half. 3) On seasonal distribution, it was most prevalent on Summer. 4) 113 cases were located on lower ureter, and laterality was even. 5) Most common symptoms were renal colic and hematuria (91.8%) 6) Ureterolithotomy was done in 127 cases. In 86 cases of lower ureter stones, less than 1cm in size. conservative fluid therapy and cystoscopic extraction was successful in 44 cases. 7) Post-operative complications were urinary leaking (16 cages), wound infection(12 cases), hematuria (3 cases), ureteral stricture (1 case), and pyelonephritis (1 case).
Constriction, Pathologic ; Female ; Fluid Therapy ; Hematuria ; Humans ; Male ; Pyelonephritis ; Renal Colic ; Seasons ; Ureter* ; Wounds and Injuries

Extracorporeal shock wave lithotripsy (ESWL) is a non-contact, non-invasive technique for disintegrating urinary tract calculi into sand-sized particles which can be passed spontaneously by a patient during normal urine flow. ESWL with an Edap lithotriptor which uses piezoelectric elements, was performed in 465 cases with urinary calculi from May 1987 to October 1988. The overall success rate of ESWL in 465 cases was 92.7% and renal stones were more successfully (95.9%) treated than ureteral stone (86.7%) main complications of ESWL for urinary calculi were hematuria (70.8%), hypertension(8.0 %). renal colic (2.6%), ileus (2.5%) and fever (1.2%) and then they were controlled without specific treatment. ESWL using ultrasonic localization was effective for treatment of the urinary stones.
Calculi ; Fever ; Hematuria ; Humans ; Ileus ; Lithotripsy* ; Renal Colic ; Shock* ; Ultrasonics ; Ureter ; Urinary Calculi* ; Urinary Tract

BACKGROUND: Ureteral colic due to acute obstruction of urine flow is a frequent and painful condition presenting in the emergency department. Proper control of ureteral colic is important in the management of such a patient. Many drugs, including narcotics, had been used to control ureteral colic, and of them, nonsteroidal anti-inflammatory drugs are most commonly used. This study was carried out to compare the analgesic effect of diclofenac with that of caroverine which is used empirically in ureteral colic. METHODS: We carried out a randomized, prospective clinical trial in the emergency department of a university hospital. Sixty patients in whom ureteral colic had been diagnosed on the basis of physical signs and symptoms were included in this study. Each patients received an IM dose of diclofenac 75 mg, a IV bolus dose of caroverine 20 mg, or a continuous infusion of caroverine 60 mg. An additional dose of medication was added 20 min after the initial medication if needed. RESULTS: The main outcome was measured by using both the visual analogue scale(VAS), four-point categorial pain scale at times of 20, 40, and 60 min after initial medication. The requirement for supplemental medication was also measured. At 40 min, diclofenac was more effective than the other two treatments according to its pain- relieving capacity(p<0.05) and the categorial pain scale. By 60 min, caroverine continuous infusion was less effective than the other two treatments according to visual analogue scale(VAS) and the categorial pain scale(p<0.05). There were no significant differences between the diclofenac group and the caroverine bolus injection group at this time. The diclofenac group needed significantly less rescue medication for pain control(p<0.05). CONCLUSION: IM diclofenac, a non-steroidal antiinflammatory drug, was superior to the spasmolytics, single bolus or continuous intravenous infused, in treatment of ureteral colic.
Diclofenac* ; Emergency Service, Hospital ; Humans ; Narcotics ; Parasympatholytics ; Prospective Studies ; Renal Colic* ; Ureter*

Squamous cell carcinoma of the renal pelvis is an uncommon tumor, comprising about 0.5-2% of all primary malignant tumor of the kidney. The patients of this disease usually presented late with extensive local infiltration. In addition, poor response to surgery, radiotherapy and chemotherapy result in a poor prognosis and short survival. We report a patient of squamous cell carcinoma of renal pelvis with staghorn calculi in a 66-year-old woman who had a history of right sided renal colic and palpable abdominal mass.
Aged ; Calculi* ; Carcinoma, Squamous Cell* ; Drug Therapy ; Female ; Humans ; Kidney ; Kidney Pelvis* ; Prognosis ; Radiotherapy ; Renal Colic