Advances in Urology最新文献

{"title":"CK20 and CK5/6 Immunohistochemical Staining of Urothelial Neoplasms: A Perspective.","authors":"Mohammed Akhtar,&nbsp;Sameera Rashid,&nbsp;Mohamed Ben Gashir,&nbsp;Noheir Mostafa Taha,&nbsp;Issam Al Bozom","doi":"10.1155/2020/4920236","DOIUrl":"https://doi.org/10.1155/2020/4920236","url":null,"abstract":"<p><p>Cytokeratins belong to the family of intermediate filaments. They are expressed in a highly specific manner in epithelial cells where they play a crucial role in the integrity and mechanical stability of the cells. Several types of cytokeratins have been described in normal as well as neoplastic urothelium. In the case of urothelial neoplasms expression of CK20 and CK5/6 has been shown in several studies to have diagnostic and prognostic implications. Thus, low-grade urothelial carcinoma manifests CK expression limited to the umbrella cells, while high-grade tumors usually have an expression in the entire thickness of the urothelium except for the basal layer. CK5/6 expression on the other hand is expressed in the basal cells in all low-grade and some high-grade urothelial carcinomas. Diffuse CK20 staining accompanied by loss of CK5/6-positive basal layer is usually associated with aggressive clinical behavior. Double staining of the slides for these cytokeratins may facilitate proper interpretation and correlation.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":"4920236"},"PeriodicalIF":1.4,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/4920236","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38854067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of the Uncommon Bladder Cancers: A Single-Center Experience over 10 Years.","authors":"Youssef Kadouri,&nbsp;Salim Lachkar,&nbsp;Hamza Dergamoun,&nbsp;Hachem El Sayegh,&nbsp;Lounis Benslimane,&nbsp;Yassine Nouini","doi":"10.1155/2020/7563703","DOIUrl":"https://doi.org/10.1155/2020/7563703","url":null,"abstract":"<p><strong>Background: </strong>Under the name of uncommon bladder cancers are gathered rare histological entities which represent less than 5% of bladder tumors. There is not a clear and consensual therapeutic management for these entities.</p><p><strong>Purpose: </strong>To review a single-institution 10-year experience with rare form of bladder cancers detailing the diagnosis, treatment, and patient outcome.</p><p><strong>Materials and methods: </strong>We performed a retrospective review of 27 medical records of rare bladder cancer form treated at our center between February 2006 and February 2015. The clinicopathologic features are reported with emphasis on treatment and survival.</p><p><strong>Results: </strong>Mean patient age was 65.5 ± 20 yr and 70% of patients were males. Smoking background was found in 16 cases, chronic bladder irritation factors were found in 12 cases, and past urinary tract infection was found in 11 cases. The main symptom was total hematuria (93%) causing an anemia in 16 cases. The two mean histological forms were epidermoid carcinoma (37%) and adenocarcinoma (22%). 26% of patients were found to have extended invasive tumors (T4) at diagnosis. Metastatic disease was confirmed in 8 cases. Our patients were managed by a wide range of therapeutic modalities as total cystectomy with bilateral lymph node dissection (63%), palliative chemotherapy (30%), or concomitant radiochemotherapy (7%). 55.6% of patients were alive one year after diagnosis. Epidermoid carcinoma has the best prognosis followed by leiomyosarcoma and sarcomatoid carcinoma. Neuroendocrine carcinoma has the worst outcome. The overall 5-year survival rate is 33.3%.</p><p><strong>Conclusion: </strong>The rarity and small size of these tumors justify the absence of clear and consensual therapeutic management. No role of total cystectomy concerning the conclusions could be drawn but elements suggest this may be the treatment of choice. The highly aggressive nature of those lesions justifies an aggressive and fast therapy when feasible which gives the best outcomes.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":"7563703"},"PeriodicalIF":1.4,"publicationDate":"2020-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/7563703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38510910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Bladder and Urethral Agenesis: Two Case Reports and Management.","authors":"Salahaddin Delshad,&nbsp;Hadith Rastad,&nbsp;Parham Mardi","doi":"10.1155/2020/2782783","DOIUrl":"https://doi.org/10.1155/2020/2782783","url":null,"abstract":"<p><strong>Background: </strong>Agenesis of the bladder and urethra is a rare congenital anomaly, with a very few living cases reported in the literature so far. <i>Case Presentation</i>. We are reporting two female patients (3 and 6 years old) with bladder and urethral agenesis who presented with urinary incontinence. In both patients, magnetic resonant imaging (MRI) revealed a case of bladder and urethral agenesis with normal ureters draining into the vagina. Patients underwent a neobladder and conduit creation surgery. The neobladder was constructed from the whole cecum and a part of the ascending colon, followed by an anastomose of the ureters into the neobladder in a nonrefluxing fashion; the appendix was used simultaneously as a continent catheterizable conduit. The two patients attained urinary continence postoperatively.</p><p><strong>Conclusion: </strong>We reported two cases of bladder agenesis, and for the first time, we have performed neobladder creation surgery using the cecum and ascending colon. One-year follow-up did not reveal any complications.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":"2782783"},"PeriodicalIF":1.4,"publicationDate":"2020-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/2782783","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38561278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of Radiographic Imaging for Infant Hydronephrosis over the First 12 Months of Life.","authors":"Anthony J Schaeffer, Patrick C Cartwright, Glen A Lau, Mark D Ebert, Nora F Fino, Flory L Nkoy, Rachel Hess","doi":"10.1155/2020/2108362","DOIUrl":"10.1155/2020/2108362","url":null,"abstract":"<p><strong>Purpose: </strong>The workup and surveillance strategies for infant hydronephrosis (HN) vary, although this could be due to grade-dependent differences in imaging intensity. We aimed to describe the frequency of imaging studies for HN within the first year of life, stratified by initial HN grade, within a large regional healthcare system. <i>Study Design and Data Source</i>. Retrospective cohort using Intermountain Healthcare Data Warehouse. Inclusion criteria: (1) birth between 1/1/2005 and 12/31/2013, (2) CPT code for HN, and (3) ultrasound (U/S) confirmed HN within four months of birth. <i>Data Collection</i>. Grade of HN on initial postnatal U/S; number of HN-associated radiologic studies (renal U/Ss, voiding cystourethrograms (VCUGs), and diuretic renal scans); demographic and medical variables. <i>Primary Outcome</i>. Sum of radiologic studies within the first year of life or prior to pyeloplasty. <i>Statistical Analysis</i>. Multivariate poisson regression to analyze association between the primary outcome and the initial HN grade.</p><p><strong>Results: </strong>Of 1,380 subjects (993 males and 387 females), 990 (72%), 230 (17%), and 160 (12%) had mild, moderate, and severe HN, respectively. Compared with those with mild HN, patients with moderate (RR: 1.57; 95% CI: 1.42-1.73) and severe (RR: 2.09; 95% CI: 1.88-2.32) HN had a significantly higher rate of imaging use over 12 months (or prior to surgery) after controlling for potential confounders.</p><p><strong>Conclusions: </strong>In a large regional healthcare system, imaging use for HN is proportional to its initial grade. This suggests that within our system, clinicians treating this condition are using a risk-stratified approach to imaging.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":"2020 ","pages":"2108362"},"PeriodicalIF":1.4,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/2108362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10389260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histological Inflammation in Human Ureter either Healthy or Fitted with Double-Pigtail Stent or a Thin 0.3 F Suture Thread: A Preliminary Study.","authors":"Benoît Vogt,&nbsp;Ilham Chokri","doi":"10.1155/2020/1204897","DOIUrl":"https://doi.org/10.1155/2020/1204897","url":null,"abstract":"Background Ureteral stent intolerance reduces patients' quality of life. It has been suggested that changes in the shape of stents could decrease discomfort. In previous studies, the innovative pigtail-suture stent (i.e., JFil® or MiniJFil®) with a thin 0.3 F suture thread significantly decreased stent-related symptoms. Fortuitously, a dilation of the ureter containing the sutures was discovered. In addition, no inflammation was seen on the ureter wall around the suture in endoscopy. In this preliminary study, we assessed ureteral inflammation in the human ureter when it was healthy or when fitted with a double-pigtail stent or a thread. Materials and Methods After consent and inclusion of patients in the protocol, fifteen segments of ureters were collected during cystectomy procedures for bladder tumors. Ureteral inflammation was assessed on the histological section stained with hematoxylin-eosin. Histological grading (cumulative range of 0 to 6) assessing inflammation was performed on the ureter section for mucosa inflammation and inflammation in the muscle layer. Results A marked ureteral inflammatory reaction was observed in all cases of ureters fitted with a double-pigtail stent with a mean inflammation score of 4.8 ± 0.4. The ureter fitted with the thin suture thread showed inflammation in only one case with a mean inflammation score of 1.8 ± 1.3 (p=0.001). Conclusion Although the study was limited by the small number of patients, it confirmed that the double-pigtail stent induced ureteral inflammation in all cases and the thin 0.3 F suture thread caused less ureteral inflammation than the double-pigtail stent. The concept of material reduction within the urinary tract seems necessary in order to decrease mucosal irritation. The JFil® or the MiniJFil® thread could meet this requirement.","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":"1204897"},"PeriodicalIF":1.4,"publicationDate":"2020-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/1204897","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38186144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removal of the Tumor Thrombus from the Right Atrium without Extracorporeal Circulation: Emphasis on the Displacement of the Tumor Apex.","authors":"D V Shchukin,&nbsp;V N Lesovoy,&nbsp;G G Khareba,&nbsp;A I Harahatyi,&nbsp;A V Maltsev,&nbsp;M M Polyakov,&nbsp;R V Stetsyshyn,&nbsp;M P Kopytsya,&nbsp;P V Mozzhakov,&nbsp;O O Makovozov","doi":"10.1155/2020/6063018","DOIUrl":"https://doi.org/10.1155/2020/6063018","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the outcomes of cavoatrial tumor thrombus removal using the liver transplantation technique for thrombectomy, a retrospective study was conducted.</p><p><strong>Materials and methods: </strong>Five patients with atrial tumor thrombi who underwent piggy-back mobilization of the liver, surgical access to the right atrium from the abdominal cavity, and external manual repositioning of the thrombus apex below the diaphragm (milking maneuver) were included into the study. Extracorporeal circulation was used in none of the cases. The average length of the atrial component of the tumor was 20.0 ± 11.7 mm (10 to 35 mm), and the width was 14.8 ± 8.5 mm (10 to 30 mm). In this work, the features of patients and surgical interventions as well as perioperative complications and mortality were analyzed.</p><p><strong>Results: </strong>External manual repositioning of the tumor thrombus apex below the diaphragm was successfully performed in all patients. Tumor thrombi with the length of the atrial part up to 1.5 cm were removed through the extrapericardial approach. For evacuation of the thrombi with the large atrial part (3.0 cm or more), a transpericardial surgical approach was required. Specific complications associated with the access to the right atrium from the abdominal cavity (paresis of the right phrenic nerve, pneumothorax, and mediastinitis) were not detected in any case. The average clamping time of the supradiaphragmatic inferior vena cava (IVC) was 6.3 ± 4.6 min. The volume of intraoperative blood loss varied from 2500 to 5600 ml (an average of 3675 ± 1398.5 ml).</p><p><strong>Conclusion: </strong>Our work represents the initial experience in the liver transplantation technique for thrombectomy in distinct and well-selected patients with atrial tumor thrombi. The effectiveness of this approach needs further study. The video presentation of our research took place in March 2019 at the 34th Annual EAU Congress in Barcelona.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":"6063018"},"PeriodicalIF":1.4,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/6063018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38114047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Learning Curve in Robot-Assisted Radical Prostatectomy Performed by a Surgeon.","authors":"Roman I Slusarenco,&nbsp;Konstantin V Mikheev,&nbsp;Artem O Prostomolotov,&nbsp;Roman B Sukhanov,&nbsp;Evgeny A Bezrukov","doi":"10.1155/2020/9191830","DOIUrl":"https://doi.org/10.1155/2020/9191830","url":null,"abstract":"<p><p>This study aimed to report the learning curve in robot-assisted radical prostatectomy (RARP) performed by one surgeon who is experienced in laparoscopic prostatectomies. The records of 145 RARP cases performed between 2015 and 2017 were evaluated retrospectively. Patients were divided into three groups: group 1 comprised the first 49 cases, group 2 comprised 50-88 cases, and the rest of the cases were assigned to group 3. Continence was defined as the necessity to use at least one pad during a day. Additionally, erectile function recovery was defined as having erection sufficient for sexual intercourse regardless of using a phosphodiesterase type 5 inhibitor. Continence and erectile function recovery were assessed during interviews at 3, 6, and 12 months after surgery. First, all procedures were successfully performed without conversions or blood transfusions. The median follow-up period was 22 months. Moreover, the median skin-to-skin operative time (OT) was 220 minutes. The median blood loss was 150 ml, and the mean hospital stay was 8.9 ± 3.87 days. The median prostate volume was 36 cm³. The overall positive surgical margin rate was 13.1%. Overall, 38 (26.2%) postoperative complications were observed, and 17.9% of them were graded as minor. Anastomotic leakage decreased significantly from group 1 to group 3 (26.5% and 7%, respectively). The continence recovery (0-1 pad) rates were 60.6%, 75.7%, and 84.9% at 3, 6, and 12 months after surgery, respectively. Subsequently, the erectile function recovery rates were 50.9% and 65.4% at 6 and 12 months after surgery, respectively. In conclusion, there are several types of learning curves for RARP. First, the shallowest learning curve was observed for the OT. Regarding the analysis of \"advanced learning curve,\" demonstrating the improvement of OT and blood loss is considered insufficient. Therefore, additional oncological and functional results that require a longer period of investigation are required.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":"9191830"},"PeriodicalIF":1.4,"publicationDate":"2020-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/9191830","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38056903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Assessment of Single-Use Ureteroscopes in an <i>In Vivo</i> Porcine Model.","authors":"Brian Ceballos,&nbsp;Charles U Nottingham,&nbsp;Seth K Bechis,&nbsp;Roger L Sur,&nbsp;Brian R Matlaga,&nbsp;Amy E Krambeck","doi":"10.1155/2020/3842680","DOIUrl":"https://doi.org/10.1155/2020/3842680","url":null,"abstract":"<p><strong>Methods: </strong>A female pig was placed under general anesthesia and positioned supine, and retrograde access to the renal collecting system was obtained. The LithoVue (Boston Scientific) and Uscope (Pusen Medical) were evaluated by three experienced surgeons, and each surgeon started with a new scope. The following parameters were compared between each ureteroscope: time for navigation to upper and lower pole calyces with and without implements (1.9 F basket, 200 <i>μ</i>m laser fiber, and 365 <i>μ</i>m laser fiber for upper only) in the working channel and subjective evaluations of maneuverability, irrigant flow through the scope, lever force, ergonomics, and scope optics.</p><p><strong>Results: </strong>Navigation to the lower pole calyx was significantly faster with LithoVue compared to Uscope when the working channel was empty (24.3 vs. 49.4 seconds, <i>p</i> < 0.01) and with a 200 <i>μ</i>m fiber (63.6 vs. 94.4 seconds, <i>p</i>=0.04), but not with the 1.9 F basket. Navigation to the upper pole calyx was similar for all categories except faster with LithoVue containing the 365 <i>μ</i>m fiber (67.1 vs. 99.7 seconds, <i>p</i>=0.02). Subjective assessments of scope maneuverability to upper and lower pole calyces when the scope was empty and with implements favored LithoVue in all categories, as did assessments of irrigant flow, illumination, image quality, and field of view. Both scopes had similar scores of lever force and ergonomics.</p><p><strong>Conclusions: </strong>In an <i>in vivo</i> porcine model, the type of single-use ureteroscope employed affected the navigation times and subjective assessments of maneuverability and visualization. In all cases, LithoVue provided either equivalent or superior metrics than Uscope. Further clinical studies are necessary to determine the implications of these findings.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":"3842680"},"PeriodicalIF":1.4,"publicationDate":"2020-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/3842680","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37923570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiome within Primary Tumor Tissue from Renal Cell Carcinoma May Be Associated with PD-L1 Expression of the Venous Tumor Thrombus.","authors":"Michael A Liss,&nbsp;Yidong Chen,&nbsp;Ronald Rodriguez,&nbsp;Deepak Pruthi,&nbsp;Teresa Johnson-Pais,&nbsp;Hanzhang Wang,&nbsp;Ahmed Mansour,&nbsp;James R White,&nbsp;Dharam Kaushik","doi":"10.1155/2020/9068068","DOIUrl":"https://doi.org/10.1155/2020/9068068","url":null,"abstract":"<p><strong>Objective: </strong>To perform a proof of concept microbiome evaluation and PD-L1 expression profiling in clear-cell renal cell carcinoma (cc-RCC) with associated tumor thrombus (TT).</p><p><strong>Methods: </strong>After IRB approval, six patients underwent radical nephrectomy (RN) with venous tumor thrombectomy (VTT). We collected fresh tissue specimens from normal adjacent, tumor, and thrombus tissues. We utilized RNA sequencing to obtain PD-L1 expression profiles and perform microbiome analysis. Statistical assessment was performed using Student's <i>t</i>-test, chi-square, and spearman rank correlations using SPSS v25.</p><p><strong>Results: </strong>We noted the tumor thrombus to be mostly devoid of diverse microbiota. A large proportion of <i>Staphylococcus epidermidus</i> was detected and unknown if this is a surgical or postsurgical contaminant; however, it was noted more in the thrombus than other tissues. Microbiome diversity profiles were most abundant in the primary tumor compared to the thrombus or normal adjacent tissue. Differential expression of PD-L1 was examined in the tumor thrombus to the normal background tissue and noted three of the six subjects had a threshold above 2-fold. These three similar subjects had foreign microbiota that are typical residents of the oral microbiome.</p><p><strong>Conclusion: </strong>Renal tumors have more diverse microbiomes than normal adjacent tissue. Identification of resident oral microbiome profiles in clear-cell renal cancer with tumor thrombus provides a potential biomarker for thrombus response to PD-L1 inhibition.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":"9068068"},"PeriodicalIF":1.4,"publicationDate":"2020-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/9068068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37717870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Tamsulosin plus Tadalafil versus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones: A Randomized Controlled Trial.","authors":"Diwas Gnyawali,&nbsp;Manish Man Pradhan,&nbsp;Prem Raj Sigdel,&nbsp;Purushottam Parajuli,&nbsp;Sampanna Chudal,&nbsp;Sujeet Poudyal,&nbsp;Suman Chapagain,&nbsp;Bhoj Raj Luitel,&nbsp;Pawan Raj Chalise,&nbsp;Uttam Sharma,&nbsp;Prem Raj Gyawali","doi":"10.1155/2020/4347598","DOIUrl":"https://doi.org/10.1155/2020/4347598","url":null,"abstract":"<p><strong>Introduction: </strong>Urolithiasis is one of the common disorder with which about 1/5^th is found in the ureter, of which 2/3^rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug.</p><p><strong>Methods: </strong>This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded.</p><p><strong>Results: </strong>Among 176 patients who were enrolled in study, 7 were lost to follow-up, and 5 people required immediate intervention. There was a significant higher stone passage rate in group A than group B (64 vs. 50; <i>P</i>=0.025) and shorter expulsion time (1.66 vs. 2.32 weeks <i>P</i>=0.001) and less number of emergency room visits and colic episodes. No significant side effects were noted during study.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":7490,"journal":{"name":"Advances in Urology","volume":" ","pages":"4347598"},"PeriodicalIF":1.4,"publicationDate":"2020-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/4347598","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37937284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}