Giant ureteral calculi.
Giant ureteral calculi are defined as weighing at least 50 g or measuring more than 5 cm in greatest diameter. Two patients with this rare entity are described.
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Giant ureteral calculi are defined as weighing at least 50 g or measuring more than 5 cm in greatest diameter. Two patients with this rare entity are described.
100 ureteral calculi were measured on X-ray films and directly on the stone after passage or removal. The largest diameters were compared. The size of the stone was radiologically overestimated for 59 stones, correct for 26 and underestimated for 15. 73 of the stones were radiologically measured within +/-25% of the actual size.
A method is described for ureteral stone extraction using a partial closure of the Dormia stone dislodger. Of 97 attempted extractions 89 (91.8 per cent) were successful. No major complications occurred. The over-all morbidity rate was 3 per cent. The technique is especially useful in removing larger ureteral calculi.
Twenty-two unilateral nonobstructing radiopaque ureteral calculi were found on excretory urography in 21 patients over a 6-year period. The calculi were frequently (12/22) not associated with pain at the time of urography. Of the 21 patients, 19 had intrarenal pelvis configuration which may limit the potential dilatation of the collecting system. Twelve calculi eventually passed spontaneously and two were removed surgically. Three remained in the ureter for prolonged periods (up to 18 months), still nonobstructing. The majority (13/22) of the calculi were in the distal third of the ureter.
A statistical analysis of 520 ureteral calculi was undertaken to elucidate the correlation between sizes of calculi and the probability of spontaneous passage. The mean length and width of 286 calculi passed spontaneously were 6.3 +/- 2.5 (S.D.) and 4.0 +/- 1.5 mm., respectively; those of 219 calculi removed surgically were 11.7 +/- 5.0 and 7.1 +/- 2.8 mm., respectively, the difference between the two groups being statistically significant. The rate of spontaneous passage of stones within one year after diagnosis was analyzed in relation to sizes of stones which were grouped at successive 1-mm. intervals both in length and width, the over-all rate of spontaneous passage being 53 per cent. It was concluded that stones larger than 8 mm. in width on x-ray films should be removed surgically, while in those smaller than 8 mm. in width higher chances of spontaneous passage by expectant treatment would be anticipated.
Twenty-three patients subjected to endoscopic ureteric meatotomy or Dormia extraction were examined for vesicoureteric reflux. Reflux into the lower third of the ureter was found in 2 asymptomatic patients. The risks of reflux from endoscopic stone removal seem to be minimal.
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Herein we describe a new technique for the removal of an impacted intramural ureteral calculus in a female patient. The stone was extracted by digital manipulation with the index finger of one hand in the bladder and the index and middle fingers of the other hand in the vagina. The relative ease of performing the procedure and the absence of any immediate and long-term postoperative morbidity and complications warrant further use of this technique.
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Intravenous glucagon and diuresis caused by diagnostic doses of sodium diatrizoate were used to treat 5 patients with ureteral colic and urographic findings consistent with partial obstruction by a ureteral calculus. Pain was relieved and the calculus passed within two hours in 4 patients and within eight hours in the fifth. No complications were noted.
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