Cost-utility analysis of shockwave lithotripsy vs ureteroscopic stone treatment in adults.

Objectives: To assess the cost-effectiveness, resource use implications, quality-adjusted life-years (QALYs) and cost per QALY of care pathways starting with either extracorporeal shockwave lithotripsy (SWL) or with ureteroscopic retrieval (ureteroscopy [URS]) for the management of ureteric stones.

Patients And Methods: Data on quality of life and resource use for 613 patients, collected prospectively in the Therapeutic Interventions for Stones of the Ureter (TISU) randomized controlled trial (ISRCTN 92289221), were used to assess the cost-effectiveness of two care pathways, SWL and URS. A health provider (UK National Health Service) perspective was adopted to estimate the costs of the interventions and subsequent resource use.

Shockwave lithotripsy compared with ureteroscopic stone treatment for adults with ureteric stones: the TISU non-inferiority RCT.

Background: Urinary stone disease affects 2-3% of the general population. Ureteric stones are associated with severe pain and can have a significant impact on a patient's quality of life. Most ureteric stones are expected to pass spontaneously with supportive care; however, between one-fifth and one-third of patients require an active intervention.

Shockwave Lithotripsy Versus Ureteroscopic Treatment as Therapeutic Interventions for Stones of the Ureter (TISU): A Multicentre Randomised Controlled Non-inferiority Trial.

Background: Renal stone disease is common and can cause emergency presentation with acute pain due to ureteric colic. International guidelines have stated the need for a multicentre randomised controlled trial (RCT) to determine whether a non-invasive outpatient (shockwave lithotripsy [SWL]) or surgical (ureteroscopy [URS]) intervention should be the first-line treatment for those needing active intervention. This has implications for shaping clinical pathways.

The clinical and cost effectiveness of surgical interventions for stones in the lower pole of the kidney: the percutaneous nephrolithotomy, flexible ureterorenoscopy and extracorporeal shockwave lithotripsy for lower pole kidney stones randomised controlled trial (PUrE RCT) protocol.

Introduction: Renal stones are common, with a lifetime prevalence of 10% in adults. Global incidence is increasing due to increases in obesity and diabetes, with these patient populations being more likely to suffer renal stone disease. Flank pain from stones (renal colic) is the most common cause of emergency admission to UK urology departments.

TISU: Extracorporeal shockwave lithotripsy, as first treatment option, compared with direct progression to ureteroscopic treatment, for ureteric stones: study protocol for a randomised controlled trial.

Background: Urinary stone disease is very common with an estimated prevalence among the general population of 2-3%. Ureteric stones are associated with severe pain as they pass through the urinary tract and have significant impact on patients' quality of life due to the detrimental effect on their ability to work and need for hospitalisation. Most ureteric stones can be expected to pass spontaneously with supportive care.

Update of the ICUD-SIU consultation on stone technology behind ureteroscopy.

Introduction: Ureteroscopy is now the most frequent treatment used around the world for stone disease. Technological advancement, efficiency, safety, and minimally invasiveness of this procedure are some of the reasons for this change of trend.

Materials And Methods: In this review of the literature, a search of the PubMed database was conducted to identify articles related to ureteroscopy and accessories.

The Role of Tandem Double-J Ureteral Stents in the Management of Malignant Ureteral Obstruction.

Aim: The management of malignant ureteral obstruction (MUO) is a challenging but common problem for urologists. The different techniques currently used to address this complicated issue include percutaneous nephrostomy, extra-anatomical stents, retrograde (single) stent insertion, and metallic stents. In those situations where single ureteral stent insertion has failed, retrograde tandem or twin ureteral stent (TUS) insertion can be completed.

Use of drug therapy in the management of symptomatic ureteric stones in hospitalized adults (SUSPEND), a multicentre, placebo-controlled, randomized trial of a calcium-channel blocker (nifedipine) and an α-blocker (tamsulosin): study protocol for a randomized controlled trial.

Background: Urinary stone disease is common, with an estimated prevalence among the general population of 2% to 3%. Ureteric stones can cause severe pain and have a significant impact on quality of life, accounting for over 15,000 hospital admissions in England annually. Uncomplicated cases of smaller stones in the lower ureter are traditionally treated expectantly.

Impact of imaging in urolithiasis treatment planning.

Purpose Of Review: Over the past 10 years, we have seen major advances in urological imaging including developments in digital imaging, ultrasound and computerized tomography (CT) scanning. All of these have had an impact on the management of urinary tract stone disease. In parallel with these, we have witnessed a greater appreciation of the potential harm of irradiation exposure.

Computed tomography for percutaneous renal access.

Abstract Successful percutaneous nephrolithotomy (PCNL) relies on appropriate preoperative planning and optimal percutaneous access. CT has now become the standard imaging tool for PCNL. For percutaneous renal access, CT may be used for planning access, guiding access, and in the follow-up after access.

Evaluation of the accuracy of 3-dimensional ultrasonography of the kidney using an in vitro renal model.

Objective: Three-dimensional ultrasonography (3DUS) has recently become a reality because of advances in ultrasound probes and machine processing ability. We have developed an anthropomorphic phantom of the human loin to assess both the accuracy of 3DUS of the kidney and its potential usefulness for training in ultrasonographically guided percutaneous renal intervention.

Methods: The model was built with easily available and inexpensive materials such as agar and latex with known ultrasonographic properties.

Three-dimensional CT pyelography for planning of percutaneous nephrostolithotomy: accuracy of stone measurement, stone depiction and pelvicalyceal reconstruction.

Retrospective evaluation of computed tomographic (CT) pyelography before percutaneous nephrostolithotomy (PCNL). Twenty patients with renal calculi underwent CT pyelography using a dedicated protocol. Calculus size, uniformity of contrast excretion and accuracy of calculus and pelvicalyceal (PC) system reconstructions were scored and compared on axial and coronal maximum intensity projections (MIP) and volume reconstructions (VRmovie loops).

A biphasic response from bladder epithelial cells induced by catheter material and bacteria: an in vitro study of the pathophysiology of catheter related urinary tract infection.

Purpose: Catheter associated urinary tract infection is the most common type of hospital acquired infection. An understanding of catheter associated urinary tract infection pathogenesis is needed to improve the control and treatment of these infections. We investigated the relationship among catheter material, bacteria and bladder epithelial cell reaction.

The risk of prostate cancer amongst South Asian men in southern England: the PROCESS cohort study.

Objective: To reinvestigate whether South Asian men in the UK are at lower risk of being diagnosed with prostate cancer in a UK-based retrospective cohort study and to examine possible reasons that may explain this.

Patients And Methods: The catchment areas were predefined in four areas of southern England, and age- and race-specific populations for those areas taken from census data. Cases were ascertained through review of multiple hospital sources, while race, other demographic factors, and medical history were determined using questionnaires sent to the men, hospital records review and death certificates.

Three-dimensional ultrasound reconstruction of the pelvicaliceal system: an in-vitro study.

Objectives: Three-dimensional (3D) reconstruction of the pelvicaliceal system (PCS) can be helpful for percutaneous renal procedures. 3D reconstruction of the PCS using ultrasound (US) has not been studied. We determined the feasibility and accuracy of 3DUS reconstruction of the PCS in an in vitro model.

Percutaneous renal intervention: comparison of 2-D and time-resolved 3-D (4-D) ultrasound for minimal calyceal dilation using an ultrasound phantom and fluoroscopic control.

The rapid advances made by ultrasound in recent years have increasingly taken 3-D ultrasound (3DUS) and 4-D ultrasound (4DUS) from the research setting to the patient's bedside. There are still unexplored areas like renal percutaneous intervention, where 4DUS has yet to be proven an effective tool. Ultrasound-only guidance in renal percutaneous access is used in selected well-dilated pelvi-calyceal systems (PCS), and fluoroscopy is often utilized as an adjunct.

Portable ultrasonography and bladder volume accuracy--a comparative study using three-dimensional ultrasonography.

Objectives: To compare the ultrasound bladder volume accuracy and level of agreement between two portable bladder scanners (Bladderscan and Bardscan) and a three-dimensional ultrasound (3D-US) system.

Methods: A total of 50 healthy volunteers were scanned using the Bladderscan BVI 3000, Bardscan, and 3D-US system (HDI 4000), in random sequence. The BVI3000 is a dedicated bladder volume calculator, and the Bardscan combines real-time ultrasonography with bladder volume calculation.

What radiation exposure can a patient expect during a single stone episode?

Purpose: There is increasing concern about the risks of radiation exposure with the advent of new, more complex imaging modalities. For example, computed tomography (CT), with its obvious advantages, is being more commonly used in the investigation of acute flank pain. The likely radiation exposure a patient can expect during a single complete urinary stone episode was studied.

A model of catheter-associated urinary tract infection initiated by bacterial contamination of the catheter tip.

Objective: To examine the microbial colonization of urinary catheters that have been used by patients, to model catheter colonization in vitro and thus provide information about the way bacteria gain access to the bladder during catheterization.

Materials And Methods: Microbial growth patterns from patients' indwelling catheters and from catheters used in an in vitro model of the catheterized urinary tract were compared. Catheters were cut into short segments, microorganisms from the inside and outside of each segment of the catheters were removed by sonication, and viable bacteria counted.

Resin polymer and corrosion casting of the porcine pelvi-calyceal system: a useful model for investigating new imaging and endoscopic techniques of the upper urinary tract.

We describe the use of polyester resin casting of the pelvi-calyceal (PC) system as a method of evaluating the accuracy of new three-dimensional imaging technology such as ultrasound and computerised tomography. Thirty-eight kidneys from large white pigs were used for the study. We describe the process of preparation of the kidney and polyester resin for injection into the PC systems.

Preventing the forgotten ureteral stent: implementation of a web-based stent registry with automatic recall application.

Objectives: To describe and analyze a unique computerized system that tracks ureteral stents and automatically sends a notice by e-mail to clinical staff if a stent becomes overdue for removal.

Methods: We have developed an electronic stent register (ESR) and stent extraction reminder facility (SERF) located within our hospital computer network. After stent insertion, a stent "episode" is created in the ESR with a mandatory maximal stent life (MSL).

The risk of prostate cancer amongst black men in the United Kingdom: the PROCESS cohort study.

Objectives: It is known that African American men have a greater risk of prostate cancer than white men. We investigated whether this was true for first-generation black Caribbean and black African men in the United Kingdom.

Methods: A clinical cohort study design recruiting all cases of prostate cancer diagnosed over a 5-yr period and residing in defined areas of London and Bristol.