On 1014 cases of useteral lithotriptoscopy carried out at Buu Dien Hospital from October 1999 to November 2002, observation showed that lithotriptoscopy is a non-invasive surgical intervention of high efficacy (91.6%). The results were well depended on the site, the size and the density of the stone and the level of water stasis in the kidney and especially to the skill of the surgeons and proper indication for each case depend on them.
Ureterolithiasis ; Ureter ; Disease ; diagnosis

Report one case of a male patient, aged 32 years old, admitted hospital due to left sciatica for two years. Ultrasound studies discovered 3-degree left hydronephrosis due to left ureterolithiasis. The patient was extraperitoneal laparoscopic pelvic ureterolithotomy. Operation time was 130 minutes; blood loss was about 10ml. The patient refarted on the first day; drainage was pulled out on the second day and discharged on the third day after operation. He only used pain relief medication on the first postoperation day. After one week, the patient was reexamined to pull out ureteral catheter. The incision healed well. Extraperitoneal laparoscopic surgery was minimally invasive, so patient could feel comfortable in postoperative period was for s
Ureterolithiasis ; Pelvis ; Laparoscopy

Background: Untill now, many minimal invasive methods have been applied in treating ureteral stones such as the endoscopic ureterolithotripsy technique of Perez-Castro and Martinez-Pinero (1980), the tetroperitoneal laparoscopic ureterolithotomy technique of Wickham (1979) and so on. Retrograde endoscopic ureterolithotripsy with holmium laser has been applied in management of ureteral stones at the Post hospital I Hanoi since 2003. Objective: To show results of retrograde endoscopic ureterolithotripsy with holmium laser in management of ureteral stones at the Post hospital I Hanoi. Subjects and method: A retrospective study was conducted in 183 patients who underwent retrograde endoscopic ureterolithotripsy with holmium laser at the Post hospital I Hanoi, from July/2003 to July/2005. Results:In 183 patients, female was more than male (54.7% versus 45.4%); the mean age was 45.4 (range 14-77). There were total 212 lithotrity stones, of which the rate of left, right, upper-third, middle-third and lower-third ureteral stone was respectively 51.9%, 48.1%, 43.2%, 22.4% and 34.4%. The mean size of ureteral stone was 15.1mm x 11.17mm and the average time of ureterolithotripsy was 48.1 minutes (range 15 -120). Conclusion: The rate of success for etrograde endoscopic ureterolithotripsy with holmium laser was high (92.9%), especially the success rate for lower-third ureteral calculi (100%) and the success rate for upper-third ureteral stones (84.8%). However, 5/165 patients (3%) who had follow-up examination for 2-4 years after surgery had ureteral stenosis. This complication was resulted from burned mucous membrane during endoscopic ureterolithotripsy with laser.
Ureterolithiasis/ surgery ; therapy ; Endoscopy/ methods ; Lasers

PURPOSE: A ureter obstruction caused by a ureteral stone results in inflammatory changes in the proximal submucosal layer and prevents the spontaneous passage of the ureteral stone. Accordingly, we analyzed the relationship between the spontaneous passage rates of ureteral stones less than 8 mm in size and serum C-reactive protein (CRP) levels and neutrophil percentages. MATERIALS AND METHODS: A total of 187 patients who were diagnosed with ureteral stones less than 8 mm in size and were managed consecutively at Keimyung University Dongsan Medical Center from January 2001 to January 2011 were retrospectively analyzed. Ureteral stone removal was defined as no ureteral stone shown in an imaging test without any treatment for 8 weeks after diagnosis. The patients were divided into three groups according to the levels of serum CRP and into two groups according to neutrophil percentage. The associations between these factors and ureteral stone passage rates were then examined. RESULTS: The ureteral stone passage rates of the low serum CRP level group, the medium serum CRP level group, and the high serum CRP level group were 94.1% (159/169), 70% (7/10), and 50.0% (4/8), respectively. The passage rates of ureteral stones in the group with a normal neutrophil percentage and in the group with a higher neutrophil percentage were 94.5% (121/128) and 83.1% (49/59), respectively (p=0.011). CONCLUSIONS: Measuring serum CRP levels and neutrophil percentages in patients with small ureteral stones of less than 8 mm is useful in predicting whether the stone will be spontaneously passed. When the serum CRP level and neutrophil percentage of a patient are high, aggressive treatment such as extracorporeal shock wave lithotripsy should be considered.
C-Reactive Protein ; Humans ; Lithotripsy ; Neutrophils ; Retrospective Studies ; Ureter ; Ureterolithiasis

PURPOSE: Ureteroscopic removal of stones (URS) has been widely used to treat ureteral stones because it is comparatively safe, has a high success rate, and enables patients to rapidly return to their daily routines. However, some patients experience pain after URS, but the incidence of acute post-URS pain remains largely unknown. This study aimed to investigate the incidence of acute postoperative pain after URS and the associated risk factors. MATERIALS AND METHODS: Data for 143 consecutive patients who underwent URS from June 2008 to December 2010 were collected. After excluding 8 patients who developed intraoperative complications, the patients were divided into two groups according to postoperative pain on the first postoperative day. Acute postoperative pain was defined as a pain score greater than 4 on a visual analogue pain scale (normal range, 0 to 10). Various factors were analyzed to identify the risk factors that could predict acute postoperative pain after URS. RESULTS: The stone-free rate without URS intraoperative complications was 95.5%. A total of 21 (14.6%) patients experienced postoperative pain on the first postoperative day. Young age, psychiatric illness, history of urinary tract infection, use of a stone basket, large stone size, and prolonged operation time were identified as risk factors for acute postoperative pain. CONCLUSIONS: The incidence of acute postoperative pain is not that low and should not be overlooked, because it is associated with postoperative complications that could result in an unscheduled hospital admission or visit. Active pain control should be contemplated after URS in young patients and in those with a history of urinary tract infection, psychiatric illness, large stone size, and prolonged operation time.
Humans ; Incidence ; Intraoperative Complications ; Pain Measurement ; Pain, Postoperative ; Postoperative Complications ; Risk Factors ; Ureter ; Ureterolithiasis ; Ureteroscopy ; Urinary Tract Infections

BACKGROUND: Incidence rate of ureterolithiasis has been increasing worldwide in general, with an especially rapid increase in the elderly, over 65 years of age. Therefore, the characteristics of geriatric patients diagnosed with uureterolithiasis in an Emergency Center were examined. METHODS: A total of 613 consecutive patients who were diagnosed with ureterolithiasis through computed tomography from January 2012 to March 2014 were analyzed retrospectively. The patients were divided in two groups: the geriatric group and nongeriatric group. RESULTS: Among the 613 patients, there were 64 geriatric patients (> or =65 years, 10.4%) and 549 nongeriatric patients (<65 years, 89.6%). In the geriatric patients, 13 patients (20.3%) appeared without any pain or with atypical types of pain, while 39 of the nongeriatric patients (7.1%) had no pain or atypical symptoms, presenting a statistically significant difference (p<0.001). Gastrointestinal symptoms such as nausea and vomiting were more common in geriatric patients than in nongeriatric patients (42.2% vs. 29.9%, p=0.044), while lower positive rate of microscopic hematuria was reported (78.1% vs. 90.5%, p=0.002). Furthermore, in geriatric patients, the positive rate of costovertebral angle tenderness was lower and distal ureter stones were found to be more common, while urine pH and serum creatinine levels were higher. CONCLUSION: In comparison to nongeriatric patients, geriatric patients with ureterolithiasis showed lower rates of renal colic and hematuria, while showing higher rates of having gastrointestinal symptoms such as nausea and vomiting. Thus, differences between these two groups should be considered in evaluating geriatric patients to prevent complications which may be caused from the late diagnosis of ureterolithiasis.
Aged ; Creatinine ; Delayed Diagnosis ; Emergencies* ; Geriatrics ; Hematuria ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Nausea ; Renal Colic ; Retrospective Studies ; Ureter ; Ureterolithiasis* ; Vomiting

Urolithiasis is one of the most common diseases of the urinary tract and the incidence has been increasing in recent years. The author made a clinical observation on 312 cases of clinical significance among the 375 cases of urolithiasis admitted to the Department of Urology, Presbyterian Medical Center, Daegu, Korea during the period from August, 1970 to July, 1976. The following results were obtained: 1. Among total admissions (1,400 cases), those with urolithiasis were 375 cases (26.8%), being the most common disease of the urinary tract. 2. Age distribution was between 2 and 85 years, showing the highest incidence in 21 to 50 years (74.1%). 3. Among 312 cases of in-patients, 225 cases were male and 87 female with 2.6 : 1 ratio. 4. Stones were located in ureter (69.2%), kidney(18.6%), bladder(9.0%) and urethra (2.9%). 5. Among those with ureterolithiasis, 62.5% of all cases were located in the lower third of the ureter. 6. Among those with renal stones, those with stag-horn calculi and bilateral stones were 25.9% and 3.5% respectively. 7. Managements included surgical intervention (61.9%), manipulation with baskets and ureteral catheters(25.6%) and other conservative(expectant) treatments (12.5%). 8. Pyuria was present in 30.1% and positive urine cultures with more than 100,000 colony per ml were obtained in 27.3% of 216 cases. 9. Serum calcium and phosphorus showed normal ranges in all cases. 10. Quantitative urinary calcium was elevated in 12.5% of 56 cases (more than 300 mg% per 24 hr) and phosphorus was reduced in 21.4% (less than 700 mg% per 24hr).
Age Distribution ; Calcium ; Calculi ; Daegu ; Female ; Humans ; Incidence ; Korea ; Male ; Phosphorus ; Protestantism ; Pyuria ; Reference Values ; Ureter ; Ureterolithiasis ; Urethra ; Urinary Tract ; Urolithiasis* ; Urology

PURPOSE: Urinary calculi is a familiar disease. A well-known complication of endourological treatment for impacted ureteral stones is the formation of ureteral strictures, which has been reported to occur in 14.2% to 24% of cases. MATERIALS AND METHODS: This was a prospective study. Ureterotripsy treatment was used on patients with impacted ureteral stones. Then, after 3 months and 6 months, the condition of these patients was assessed by means of a kidney-ureter-bladder (KUB) ultrasound. If the KUB ultrasound indicated moderate to serious hydronephrosis, the patient was further assessed by means of a computed tomography intravenous urogram or retrograde pyelogram to confirm the occurrence of ureteral strictures. RESULTS: Of the 77 patients who participated in the study, 5 developed ureteral strictures. Thus, the stricture rate was 7.8%. An analysis of the intraoperative risk factors including perforation of the ureter, damage to the mucous membrane, and residual stone impacted within the ureter mucosa revealed that none of these factors contributed significantly to the formation of the ureteric strictures. The stone-related risk factors that were taken into consideration were stone size, stone impaction site, and duration of impaction. These stone factors also did not contribute significantly to the formation of the ureteral strictures. CONCLUSIONS: This prospective study failed to identify any predictable factors for ureteral stricture formation. It is proposed that all patients undergo a simple postoperative KUB ultrasound screening 3 months after undergoing endoscopic treatment for impacted ureteral stones.
Constriction, Pathologic/*diagnosis ; Humans ; Hydronephrosis/diagnosis ; Kidney/ultrasonography ; Prospective Studies ; Risk Factors ; Ureter/*pathology/ultrasonography ; Ureteral Calculi/*therapy ; Ureterolithiasis/*surgery ; Ureteroscopy/*adverse effects ; Urinary Bladder/ultrasonography

PURPOSE: We presented our initial clinical experiences with transumbilical laparoendoscopic single-site (LESS) ureterolithotomy for large, impacted ureteral stones. MATERIALS AND METHODS: Between March 2009 and November 2009, seven LESS ureterolithotomies were performed at our institute. During the operation, we made a single 2 cm incision at the umbilicus and a homemade port by using a small wound retractor (Alexis(R), Applied Medical, Rancho Santa Margarita, USA), a surgical glove, and conventional trocars. The operation was performed in the same manner as conventional laparoscopic surgery. The mean maximal stone diameter was 21.9 mm (range, 16.0-27.0 mm). There were six cases of upper ureteral stones and one case of a mid-ureteral stone. Perioperative and postoperative parameters were evaluated. RESULTS: The mean operative time was 197.1 min (range, 150-270 min). No transfusions were required. The mean postoperative hospital stay was 3.3 days (range, 2-6 days). The mean pain intensity on a visual analogue scale (VAS) on postoperative day 2 was 26 mm (range, 0-80 mm), and the mean cosmetic VAS at 6 weeks after the operation was 0 mm. The mean time for patients to return to their baseline activities was 4.0 days (range, 3-7 days). In six cases, all stones were completely removed on the basis of postoperative radiologic evaluation. There were no cases of major complications, including internal organ injury, urinary leakage, or urinary tract infection. CONCLUSIONS: Transumbilical LESS ureterolithotomy can be considered as an alternative treatment option with minimal invasiveness and good effectiveness for large, impacted ureteral stones.
Cosmetics ; Gloves, Surgical ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Surgical Instruments ; Surgical Procedures, Minimally Invasive ; Umbilicus ; Ureter ; Ureterolithiasis ; Urinary Tract Infections

OBJECTIVE: The aim of this study was to evaluate the effect of adding bedside ultrasonography to the diagnostic algorithm for nephrolithiasis on emergency department (ED) length of stay. METHODS: A prospective, randomized, controlled pilot study was conducted from October 2014 to December 2014 with patients with acute flank pain. In the non-ultrasonography group (NUSG), non-contrast computed tomography was selected based on clinical features and hematuria in the urinalysis. In the ultrasonography group (USG), non-contrast computed tomography was selected based on clinical features and hydronephrosis on bedside ultrasonography. The primary outcome was ED length of stay. The secondary outcomes were radiation exposure, amount of analgesics, proportion of patients with diseases other than ureteral calculus, and proportion of patients with unexpected ED revisits within 7 days from the index visit. RESULTS: A total of 103 patients were enrolled (NUSG, 51; USG, 52). The ED length of stay for the USG (89.0 minutes) was significantly shorter than that for the NUSG (163.0 minutes, P<0.001). There were no significant differences between the two groups in the radiation exposure dose (5.29 and 5.08 mSv, respectively; P=0.392), amount of analgesics (P=0.341), proportion of patients with diseases other than ureteral calculus (13.0% and 6.8%, respectively; P=0.486), and proportion of patients with unexpected ED revisits within 7 days from the index visit (7.8% and 9.6%, respectively; P=1.000). CONCLUSION: The use of early bedside ultrasonography for patients with acute flank pain could reduce the ED length of stay without increasing unexpected ED revisits.
Analgesics ; Emergencies* ; Emergency Service, Hospital* ; Flank Pain ; Hematuria ; Humans ; Hydronephrosis ; Length of Stay* ; Nephrolithiasis ; Pilot Projects* ; Prospective Studies ; Radiation Exposure ; Renal Colic* ; Ultrasonography* ; Ureteral Calculi ; Ureterolithiasis ; Urinalysis