Comparative efficacy of 22 drug interventions as medical expulsive therapy for ureteral stones: a systematic review and network meta-analysis
AbstractTo perform a systematic review and meta-analysis for the evaluation of 22 drug interventions in the management of ureteral stones, MEDLINE, Web of Science, EMBASE, and Cochrane central databases were searched to identify RCTs focusing on the evaluation of the efficacy of multiple drug interventions in medical expulsive therapy (MET) for ureteral stones, with no restrictions on year or language. Study quality assessment and data extraction were performed by independent reviewers. Major outcome measures were the stone expulsion rate, stone expulsion time, and pain episodes during treatment. A total of 78 RCTs with 14,922 participants were included in the present study. The final comparative results show that naftopidil plus corticosteroids was associated with higher stone expulsion rates than other drug interventions. Silodosin plus tadalafil had the highest probability of reducing stone expulsion time. Tamsulosin plus tadalafil performed better than all the other drug interventions in reducing pain episodes during treatment. However, in terms of all the outcome measures, the ranking plot results demonstrate that silodosin plus tadalafil, in addition to tamsulosin plus tadalafil and corticosteroids, was the best drug intervention as medical expulsive therapy in the management of ureteral stones. In ureteral stones ≤ 10 mm, all active drug interventions were more efficacious than the control; however, not all active drug interventions had an effica...
In this report, we discuss the identification and management of this rare condition.
Conclusion: In the treatment of 2-4 cm renal stone, using V-UAS in RIRS can improve surgical efficiency with lower postoperative early pain scores. Comparing with MPCNL, its initial SFR was more depressed, and there is still a trend towards requiring more auxiliary procedures to achieve comparable final SFR. PMID: 32509870 [PubMed - in process]
DiscussionThe PUrE trial aims to provide robust evidence on health status, quality of life, clinical outcomes and resource use to directly inform choice and National Health Service provision of the three treatment options.Trial registrationISRCTN:ISRCTN98970319. Registered on 11 November 2015.
Conclusion: Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm. PMID: 32411212 [PubMed]
We report on two cases treated with our standardized laparoscopic technique using only three 5-mm trocars. The proposed approach could be considered as the first-line treatment for RCU. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abstract | open access Full text
AbstractBackgroundWe sought to determine the rate of emergency department (ED) attendance for complications after ureterorenoscopy (URS) for stone disease and to identify risk factors for ED attendance after URS.MethodsAn analysis of all patients undergoing URS over 12 months at a single institution was performed. Patient demographics, preoperative and intraoperative variables associated with postoperative complications and subsequent ED attendance were collected. Logistic regression analyses were performed to determine predictors of URS complications presenting to ED.ResultsIn total, 202 ureteroscopies were performe...
Conclusion: Pain was the commonest indication for intra-corporeal lithotripsy (92.8%) and also the commonest post-operative complication (9.30%). Funding: None declared. PMID: 32116343 [PubMed - in process]
Condition: Nephrolithiasis Interventions: Drug: Mirabegron 50 MG; Drug: Placebo oral tablet Sponsors: St. Michael's Hospital, Toronto; Canadian Urological Association Recruiting
We report outcomes of our initial experience with LP in 38 children from 2 months of age. Materials and Methods From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported. Results Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the ...