Impaction and Prediction: Does Ureteral Wall Thickness Affect the Success of Medical Expulsive Therapy in Pediatric Ureteral Stones?

Abstract

Objective: The study aimed to evaluate the predictive value of ureteral wall thickness (UWT) and stone-related parameters for medical expulsive therapy (MET) success with an alpha blocker in pediatric upper ureteral stones. Patients and Methods: A total of 35 children receiving MET ureteral stones (<10 mm) were evaluated. Patients were divided into 2 subgroups where MET was successful in 18 children (51.4%) and unsuccessful in 17 children (48.6%). Prior to management, stone size, stone density (in Hounsfield unit), degree of hydronephrosis, and UWT were evaluated with patient demographics and recorded. The possible predictive value of these parameters in success rates and time to stone expulsion were evaluated in a comparative manner between the 2 groups. Results: The overall mean patient age and stone size values were 5.40 ± 0.51 years and 6.24 ± 0.28 mm, respectively. Regarding the predictive values of these parameters for the success of MET, while stone size and UWT were found to be highly predictive for MET success, patients age, body mass index, stone density, and degree of hydronephrosis had no predictive value on this aspect. Conclusions: Our findings indicated that some stone and anatomical factors may be used to predict the success of MET in pediatric ureteral stones in an effective manner. With this approach, unnecessary use of these drugs that may cause a delay in removing the stone will be avoided, and the possible adverse effects of obstruction as well as stone-related clinical symptoms could be minimized.

Ureteral stricture formation after endoscopic removal of obstructing stones: could it be predicted with well-assessed radiological parameters?

“…Studies have revealed well that the thickness of the ureteric wall surrounding the stone could be a reliable sign of such alterations which seem to increase parallel to the severity of impaction [12]. Related with this issue, the possible predictive value of the ureteral wall thickness (UWT) has been well evaluated to assess the degree of stone impaction and in one of our studies, we were able to demonstrate a signifcant relationship between the UWT values and obstruction degree in patients with acute ureteral obstruction [12,13,14]. In addition, we were able to show the predictive value of UWT assessment on the outcomes of medical and interventional procedures for such stones [12,15,16].…”

Prediction of the success rates after endoscopic treatment of stone related ureteral stricture: Could the assesement of ureteral wall thickness play a role?

“…Studies have revealed that the thickness of the ureteric wall surrounding the stone could be a reliable sign of such alterations which tend to increase parallel to the severity of tissue changes [19]. The possible predictive value of the UWT was evaluated to assess the degree of stone impaction and we were able to demonstrate a signifcant relationship between the UWT values and the degree obstruction in cases with upper tract stones [20,21]. More importantly, the predictive value of UWT assessment on the outcomes of medical and interventional procedures have also been demonstred in our previous studies [19,22,23].…”

“…A certain percentage of such ureteral strictures can be highly morbid and recurrent which could require possible several endoscopic and/or other procedures (including reconstructive approaches) [4,7,8]. Postoperative ureteral strictures is reported to occur in 1-4% of patients after ordinary URS; however, it occurs in 7.8-24% of patients when URS is performed for impacted stones [10][11][12][13].…”

Medical Expulsive Therapy for Symptomatic Distal Ureter Stones: Is the Combination of Bromelain and Tamsulosin More Effective than Tamsulosin Alone? Preliminary Results of a Single-Center Study

“…Accordingly, Tuerxun et al [40] emphasized the role of the ureteral wall thickness, due to inflammatory reaction-induced tissue changes derived from stone impact into the ureteral wall, as a predictive factor for final stone expulsion rates. The use of bromelain can prevent and treat this edematous reaction, which is an additional obstacle to the descent of the stone [41].…”