Ureteral stones tend to induce inflammatory lesions in the ureteric wall; such lesions may interfere with the probability of spontaneous ureteral stone passage. Plasma C-reactive protein (CRP) is an acute-phase protein whose serum level is increases in response to inflammation, as in ureteric inflammatory disorders induced by stone impaction. Patients with distal ureteric stones were included in this study. All patients were subjected to history taking KUB, urinary tract ultrasound, Non-contrast CT (NC-CTKUB) scan, and plasma CRP estimation. All patients received medical expulsive therapy. Patients were examined weekly using KUB and urinary tract ultrasound until spontaneous stone passage or intervention after 4 weeks. Patients who failed to expel the stone within 4 weeks underwent ureteroscopy. Spontaneous stone expulsion within 4 weeks was recorded in 129 patients (54.9 %), while 106 patients (45.1 %) underwent ureteroscopy for stone extraction. Patients with spontaneous stone expulsion had significantly lower serum CRP levels (16.45 + 2.58) than those who failed to pass the stone spontaneously (39.67 + 6.30). Receiver operator characteristic curve is used to determine CRP cut-off point for prediction of spontaneous ureteric stone expulsion. A cut-off point of 21.9 mg/L for CRP yielded appeared optimal for prediction of spontaneous ureteric stone expulsion. Medical expulsive therapy success for management of small distal ureteric calculi could be predicted with plasma CRP. Patients with CRP>21.9 mg/L have low stone expulsion rate and should directly be subjected for an immediate, minimally invasive ureteroscopy.

ObjectivesTo evaluate the efficacy of tamsulosin for promoting ureteric stone expulsion in children, based on the confirmed efficacy of tamsulosin as a medical expulsive therapy in adults.Patients and methodsFrom February 2010 to July 2013, 67 children presenting with a distal ureteric stone of <1 cm as assessed on unenhanced computed tomography were included in the study. The patients were randomised into two groups, with group 1 (33 patients) receiving tamsulosin 0.4 mg and ibuprofen, and group 2 (34) receiving ibuprofen only. They were followed up for 4 weeks. Endoscopic intervention was indicated for patients with uncontrolled pain, recurrent urinary tract infection, hypersensitivity to tamsulosin and failure of stone passage after 4 weeks of conservative treatment.ResultsSixty-three patients completed the study. There were no statistically significant differences between the groups in patient age, body weight and stone size, the mean (SD) of which was 6.52 (1.8) mm in group 1 vs. 6.47 (1.79) mm in group 2 (P = 0.9). The mean (SD) time to stone expulsion in group 1 was 7.7 (1.9) days, vs. 18 (1.73) days in group 2 (P < 0.001). The analgesic requirement (mean number of ketorolac injections) in group 1 was significantly less than in group 2, at 0.55 (0.8) vs. 1.8 (1.6) (P < 0.001). The stone-free rate was 87% in group 1 and 63% in group 2 (P = 0.025).ConclusionsTamsulosin used as a medical expulsive therapy for children with ureteric stones is safe and effective, as it facilitates spontaneous expulsion of the stone.

Objective: To compare both the dorsal onlay technique of Barbagli and the dorsal inlay technique of Asopa for the management of long anterior urethral stricture. Methods: From January 2010 to May 2012, a total of 47 patients with long anterior urethral strictures were randomized into two groups. The first group included 25 patients who were managed by dorsal onlay buccal mucosal graft urethroplasty. The second group included 22 patients who were managed by dorsal inlay buccal mucosal graft urethroplasty. Different clinical parameters, postoperative complications and success rates were compared between both groups. Results: The overall success rate in the dorsal onlay group was 88%, whereas in the dorsal inlay group the success rate was 86.4% during the follow-up period. The mean operative time was significantly longer in the dorsal onlay urethroplasty group (205 ± 19.63 min) than in the dorsal inlay urethroplasty group (128 ± 4.9 min, P-value <0.0001). The average blood loss was significantly higher in the dorsal onlay urethroplasty group (228 ± 5.32 mL) than in the dorsal inlay urethroplasty group (105 ± 12.05 mL, P-value <0.0001). Conclusions:The dorsal onlay technique of Barbagli and the dorsal inlay technique of Asopa buccal mucosal graft urethroplasty provide similar success rates. The Asopa technique is easy to carry out, provides shorter operative time and less blood loss, and it is associated with fewer complications for anterior urethral stricture repair.Key words: anterior uretheral sricture, buccal mucosal graft, dorsal inlay technique of Asopa, dorsal onlay technique of Barbagli.

The scoring systems analyzed could be used to predict success of percutaneous nephrolithotomy in the pediatric setting. However, further studies are needed to formulate modifications for use in children. The main variables in the scoring systems, ie stone burden, tract length and case volume, were measured using records from adult patients. Besides these variables, the relatively small pelvicalyceal system and higher incidence of anatomical malformations in children could potentially affect percutaneous nephrolithotomy outcomes.

Previous open pyelolithotomy or nephrolithotomy does not affect the efficacy and morbidity of subsequent PCNL in pediatric patients.

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