ㅤTake-home message from Ranan Dasgupta 2021, published in European Urology):
The proportion of patients who need re-intervention for the management of ureteric stones is 12% higher in those treated with SWL compared to URS at 6 months (22% for SWL vs 10% for URS)
SWL considered "non-inferior" as difference of 12% was less than predefined threshold of 20%
There were similar levels of serious adverse events when comparing SWL and URS for ureteric stone management at 6 months (4% for SWL vs 3% for URS)
The shockwave lithotripsy pathway is more cost-effective in an NHS setting, but results in lower quality of life.
ㅤTake-home message from Ye 2017, published in European Urology:
This very large RCT showed benefit of tamsulosin in a select population of distal ureteric stones.
Selective use in larger stones (e.g. 5mm) is more justified based on this study and is concurrent with some other randomised studies.
Though no difference in side effects were reported, this does not fit with other studies were placebo groups had lower rates of side effects.
ㅤTake-home message from Campschroer 2018, published in BJUI:
In patients with ureteric stones, a-blockers likely increase stone clearance but probably also slightly increase the risk of major adverse events.
Subgroup analyses suggest that a-blockers may be less effective in smaller (≤5 mm) than larger stones (>5 mm).
ㅤTake-home message from Sur 2014, published in European Urology:
Data from the multicentre RCT suggest a-blockers may have a role in distal ureteric stones, or larger stones.
Patients should nonetheless be counselled on a-blocker use as it is unlicensed in the UK and comes with side effects.
Should be interpreted with caution given the small sample size and imaging techniques (US KUB)
ㅤTake-home message from Pickard 2015, published in The lancet:
The article concludes that neither tamsulosin nor nifedipine showed any clinically useful benefit for increasing stone passage, and the past studies that showed a positive benefit may be limited due to small sample sizes, differences in inclusion criteria, and inadequate masking of participants and assessors.
The findings of the SUSPEND trial provide strong evidence that these drugs are unlikely to be useful in routine clinical care of people with ureteric colic.
The trial provides some of the highest quality evidence about clinical effectiveness of MET
ㅤTake-home message from Furyk 2014, published in Annals of Emergency Medicine:
In larger (>5mm) distal stones, a-blockers may potentially increase stone passage rates (however, in this study the number needed to treat was 4.5).
However, no benefit was seen in stones >10mm or <5mm
ㅤTake-home message from H Mokhmalji 2001, published in The Journal of Urology):
Nephrostomy insertion is better than ureteric stent insertion for patients presenting ureteric stones and hydronephrosis.
Nephrostomy insertion was more successful, and better tolerated with reduced rate of postoperative infection as well as shorter duration of treatment, as compared with stents.
ㅤTake-home message from Pearle 1998, published in Journal of Urology):
This randomised controlled trial of percutaneous nephrostomy vs retrograde ureteral catheterisation for the infected obstructed kidney showed no difference in time to resolution of fever and normalisation of white cell count between groups. Percutaneous nephrostomy was less expensive, but associated with higher levels of reported back pain.
ㅤTake-home message from Maria Ordonez 2019, published in Cochrane Database of Systematic Reviews ):
The insertion of ureteral stent after uncomplicated ureteroscopy was associated with:
Increased post-operative pain at day 4 to 30, but no difference at day 0 or 1-4
Reduced unplanned visits to emergency or urgent care (21 fewer per 1000), but this did not reach statistical significance
No benefit in terms of need for secondary intervention
...when compared to not inserting a ureteral stent, but these were of low level certainty of evidence
ㅤTake-home message from Ghulam Nabi 2007, published in British Medical Journal):
Stenting after ureteroscopy is associated with greater incidence of frequency/urgency and dysuria compared to no stenting.
No evidence to suggest increased usage of postop analgesia, UTI, stone clearance rates and ureteric stricture development for stenting after ureteroscopy compared to no stenting.
BUT marked heterogeneity and poor quality of reporting of the included trials
ㅤTake-home message from Taimur Shah 2019, published in BJU International):
Overall rate of spontaneous stone passage (SSP) for conservative management of all ureteric stones = 74%
Larger stone size and proximal position were independently associated with failed SSP
ㅤTake-home message from A Skolarikos 2010, published in Journal of Endourology):
2/3rd of all symptomatic ureteric calculi pass spontaneously within 4 weeks of onset of symptoms
Symptoms or need for intervention for asymptomatic renal calculi: approximately 10% per year
21% of CIRFs (<=4mm) after SWL needed intervention at 5 years (Osman 2005)
43% of residual fragments after PCNL are associated with stone related event within 41 months (Raman 2009)
ㅤTake-home message from Bhaskar K Somani 2017, published in World Journal of Urology):
Urinary stones in pregnancy require careful multidisciplinary management to achieve good outcomes for both mother and baby.
ㅤTake-home message from Enrique Perez Castro 2014, published in European Urology):
Ureteric stone location influences stone-free rates after ureteroscopy - lower stone-free rates are seen with stones in proximal or multiple locations
Ureteric stone location influences overall complication rates with ureteroscopy - higher complication rates are seen with stones in proximal or multiple locations
ㅤTake-home message from John M Hollingsworth 2016, published in The BMJ):
There is moderate evidence that patients treated with alpha blockers have a 49% higher risk of stone passage
Patients with larger stones that are treated with an alpha blocker have a greater chance of stone passage regardless of their location
Patients who received alpha blockers had significantly shorter times to stone passage, fewer episodes of pain, lower risks of surgical intervention, lower risks of admission to hospital.