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Alpha-Adrenergic Blockers with or without Deflazacort for the Expulsion of a Lower Ureteric Calculus ≤ 10 mm: A Comparative Study

ABSTRACT

Introduction: A lower ureteric calculus is one of the most commonly encountered conditions in daily urological practice. There are various options for management of lower ureteric calculus, which includes watchful waiting, extracorporeal shock wave lithotripsy (ESWL), and ureteroscopic lithotripsy (URSL). The aim of our study was to evaluate the efficacy of following drugs in the expulsion of a lower ureteric calculus ≤ 10 mm. The drugs used are (1) tamsulosin, (2) naftopidil, (3) tamsulosin and deflazacort, and (4) naftopidil and deflazacort.

Methods: A prospective study was carried out in the Department of Urology from August 2012 to January 2013. A total of 150 patients were enrolled and were randomized into 5 equal groups of 30: A (control), B (naftopidil), C (tamsulosin), D (naftopidil and deflazacort), and E (tamsulosin and deflazacort). Complete hemograms; blood urea; serum creatinine; urine routine examination and culture and sensitivity; X-ray of the kidney, ureter, and bladder (KUB); and/or ultrasonography were done in all cases. Cases were followed up to 30 days or upon spontaneous passage of the calculus, whichever was earlier. X-ray KUB and/or ultrasonography were done to confirm the passage of the stone.

Results: The expulsion rate for a calculus ≤ 10 mm was statistically significant in all the groups in comparison to the control group. The mean days of expulsion and use of analgesics was also low in all the groups compared to control. Amongst all groups, the stone expulsion rate was highest, and episodes of pain and mean days of expulsion were lowest for the D group.

Conclusion: It is concluded that alpha-adrenergic blockers facilitate the expulsion of lower ureteric stones ≤ 10 mm and decreases the episodes of colic, which is further improved by the addition of deflazacort. Naftopidil plus deflazacort gives the best results in regards to stone expulsion rates, mean days of expulsion, and episodes of colic.


Mandeep Phukan, Debanga Sarma, Rajeev T. Puthenveetil, Sasanka K. Barua, Saumar J. Baruah

Department of Urology, Gauhati Medical College, Bhangagarh, Guwahati, Assam, India

Submitted August 28, 2013 - Accepted for Publication September 27, 2013


KEYWORDS: Lower ureteric calculus, medical expulsive therapy, alpha-adrenergic blocker

CORRESPONDENCE: Mandeep Phukan, Department of Urology, Gauhati Medical College, Bhangagarh, Guwahati, Assam, India 781032 ()

CITATION: UroToday Int J. 2013 October;6(5):art 62. http://dx.doi.org/10.3834/uij.1944-5784.2013.10.09

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Obstructive Effect of a Urethral Catheter During Voiding: Myth or Reality?

ABSTRACT

Introduction: Whether or not the presence of a urethral catheter can provoke an obstructive effect during voiding remains a controversial subject. Using the Valentini–Besson–Nelson (VBN) mathematical micturition model, the purpose of this study was to compare the geometric effect of the urethral catheter in regards to the effect of other mechanical parameters likely to influence the voiding phase during a urodynamic study.

Methods: The VBN mathematical micturition model was used to compute theoretical voidings. Starting from defined voiding conditions (Qmax) such as Vini = 300 mL, no catheter, normal detrusor contractility, and no urethral compression, we searched for relationships between changes in Qmax and the studied parameters: catheter diameter (Fr), detrusor contractility (k), and urethral compression (urac).

Results: A linearized approximation was obtained for both genders. The geometric obstruction due to the catheter was almost negligible for nonobstructed individuals compared with the volume effect up to a 6 Fr catheter size. Large decreases in Qmax resulted from impaired detrusor contractility or urethral compression. Higher effects resulted from concomitant decrease in detrusor contractility and urethral compression. Geometric effect of the catheter could lead to overestimation of bladder outlet obstruction in men.

Conclusion: A decrease in Qmax during voiding cystometrogram was found to be more often related to causes other than the catheter size, which, based on the VBN model, appeared to have a weak (almost negligible for nonobstructed individuals) effect, especially for small sizes (≤ 6 Fr).


Françoise A. Valentini,1,2 Pierre P. Nelson,1 Philippe E. Zimmern3

1ER6 – Université Pierre et Marie Curie, Paris, France; 2Service de Rééducation Neurologique, Hôpital Rothschild, Paris, France; 3The University of Texas, Southwestern Medical Center, Dallas, Texas, United States

Submitted July 5, 2013 - Accepted for Publication September 27, 2013


KEYWORDS: Catheter, flow rate, mathematical modeling, urodynamics

CORRESPONDENCE: Françoise A. Valentini, Service de Rééducation Neurologique, Hôpital Rothschild, 5, rue Santerre, 75012, Paris, France (, )

CITATION: UroToday Int J. 2013 October;6(5):art 60. http://dx.doi.org/10.3834/uij.1944-5784.2013.10.07

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Bladder Diverticulum with Stone and Transitional Cell Carcinoma: A Case Report

ABSTRACT

The incidence of bladder diverticulum is approximately 1.7% in children and 6% in adults. Dysplasia, leukoplakia, and squamous metaplasia and stone formation may develop in diverticulum and sometimes with malignant changes. The most common histological subtype of diverticulum tumors is transitional cell carcinoma (TCC). Herein we report 2 such cases of transitional cell carcinoma arising in diverticulum of the urinary bladder, one of which was associated with diverticular stones.


Sankar Prasad Hazra, Vinod Priyadarshi, Nipun Awasthi, Debashish Chakrabarty, Dilip Kumar Pal

Institute of Post Graduate Medical Education and Training, Kolkata, West Bengal, India

Submitted May 28, 2013 - Accepted for Publication September 5, 2013


KEYWORDS: Bladder diverticulum, stone, transitional cell carcinoma

CORRESPONDENCE: Vinod Priyadarshi, MBBS, MS, Institute of Post Graduate Medical Education and Training, Kolkata, West Bengal, India

CITATION: UroToday Int J. 2013 October;6(5):art 58. http://dx.doi.org/10.3834/uij.1944-5784.2013.10.05

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Tubeless, Stentless Percutaneous Nephrolithotomy: An Initial Study

ABSTRACT

Objective: To study the ability of rendering our patients tube and stent free after percutaneous nephrolithotomy (PNL).

Patients and Methods: Between February 2011 and March 2012, 38 patients (40 units) with 20 to 60 mm (mean: 31.17) renal stones underwent tubeless stentless PNL. The sample consisted of 28 males and 10 females, and their ages ranged between 17 and 65 years (mean: 33.7). Twenty-two cases were in the right kidney while 18 were in the left, and the stones were bilateral in 2. Most of the stones were in the renal pelvis and lower calyx and removed through the lower calyx subcostal with a single puncture. After ensuring that the patient was almost stone free, no nephrostomy was left and the ureteric catheter was removed within 30 minutes.

Results: Operative time ranged between 15 and 80 mins (mean: 42.34) and no blood transfusion was needed. The mean reduction in hemoglobin level was 1.52 gm (range: 0.3 to 4.8) and the hospital stay ranged between 12 to 36 hours (mean: 17.7). The success rate was 100% while the stone free rate was 95%. Analgesia was needed in 20% of cases. There were no intraoperative complications while postoperative complications occurred in 3 patients (9.7%) in the form of leakage, perirenal collection, and secondary hemorrhage.

Conclusion: Tubeless, stentless PNL is safe with acceptable complications, provided patients are stone free with no or minimal extravasations, have acceptable bleeding, and there is a single puncture. It decreases hospital stay, postoperative pain, and the need for analgesia, and subsequently lowered work abstinence. A further study with a larger sample is needed.


Tawfik H. Al- Ba’adani, Qaid Al-Ghashami, Shihab Al Germozi, Salah Ahmed, Shoukry Al Flahi, Ibrahim Al-Nadhari, Gamil Al Alimi, Walid Al Asbahi, Khalid Telha, Ibrahim El-Nono

Urology Department, Urology and Nephrology Center, Thawra Hospital, Sana'a University, Sana'a, Yemen

Submitted May 16, 2013 - Accepted for Publication September 13, 2013


KEYWORDS: Stentless, tubeless, PNL

CORRESPONDENCE: Tawfik H. Al- Ba’adani, Urology Department, Urology and Nephrology Center, Thawra Hospital, Sana'a University, Sana'a, Yemen ()

CITATION: UroToday Int J. 2013 October;6(5):art 57. http://dx.doi.org/10.3834/uij.1944-5784.2013.10.04

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Spontaneous Dissolution Mid-Shaft of a Double-J Ureteric Stent

ABSTRACT

A vanishing shaft of a double-J uretric stent is a rare complication of a “forgotten” ureteric stent. A retained “forgotten” ureteric stent is not only disastrous for the patient but also comes with severe medicolegal implications for the treating urologist. Herein we report such a case with its subsequent management.


Hemant Kumar Goel, Dilip Kumar Pal, Nipun Awasthi, Anupkumar Kundu, Shwetank Mishra, Vinod Priyadarshi, Praveen Pandey

M. S., I. P. G. M. E. & R. and S. S. K. M. Hospital, Kolkata, West Bengal, India

Submitted March 3, 2013 - Accepted for Publication September 5, 2013


KEYWORDS: DJ stent, forgotten

CORRESPONDENCE: Hemant Kumar Goel, M. S., I. P. G. M. E. & R. and S. S. K. M. Hospital, Kolkata, West Bengal, India ()

CITATION: UroToday Int J. 2013 October;6(5):art 56. http://dx.doi.org/10.3834/uij.1944-5784.2013.10.03

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