Non-invasive evaluation of obstruction after ureteroscopic stone removal: Role of renal resistive index assessment
Objectives: The aim of this study is to evaluate prediction of postoperative ureteral obstruction needing ureteral stent insertion by evaluating the resistive index (RI) values and the grade of hydronephrosis.
Material and Methods: A total of 66 adult patients undergoing stentless endoscopic ureteral stone treatment (URS) between January 2018 and January 2019 were included in this prospective study. Preoperative patient and stone characteristics were noted. All patients were evaluated with renal Doppler ultrasonography study to assess degree of hydronephrosis and RI values. A renal Doppler ultrasonography was repeated at postoperative 1st, 3rd and 7th days. Changes in both RI and hydronephrosis levels before and after the procedures were noted. On the postoperative 7th day, patients were divided into two groups including obstructive and non-obstructive cases according to RI values assessed where a RI value of 0.7 was accepted as the cut-off for obstruction. The preoperative and perioperative characteristics of both groups were evaluated in a comparative manner.
Results: The mean patient age was 43.6 ± 1.72 years. Significant improvements were noted in RI and grade of hydronephrosis after the operation. The grade of hydronephrosis and RI values were found to improve more significantly on postoperative 3rd day when compared to the postoperative 7th day (p < 0.01 and p < 0.01). A significant correlation was detected between the grade of hydronephrosis (>grade 2) and obstructive RI values (> 0.7) in each postoperative visits (p: 0.001). RI values (> 0.7) at postoperative seventh days were correlated with larger mean stone size, increased ureteral wall thickness, increased diameter of the ureter proximal to the stone, and longer duration of the operation. Preoperative high-grade hydronephrosis indicated obstructive RI values at postoperative seventh day (p = 0.001)
Conclusion: Changes in RI values on Doppler sonography and the grade of hydronephrosis may be a guiding parameter in assessing postoperative ureteral obstruction.
Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med. 2004;350(7):684-93.
Joshi HB, Obadeyi OO, Rao PN. A comparative analysis of nephrostomy, JJ stent and urgent in situ extracorporeal shock wave lithotripsy for obstructing ureteric stones. BJU Int. 1999;84(3):264-9.
Yencilek F, Sarica K, Erturhan S, Yagci F, Erbagci A. Treatment of ureteral calculi with semirigid ureteroscopy: where should we stop? Urol Int. 2010;84(3):260-4.
Apoku IN, Ayoola OO, Salako AA, Idowu BM. Ultrasound evaluation of obstructive uropathy and its hemodynamic responses in southwest Nigeria. Int Braz J Urol. 2015;41(3):556-61.
Platt JF, Rubin JM, Ellis JH. Distinction between obstructive and nonobstructive pyelocaliectasis with duplex Doppler sonography. AJR Am J Roentgenol. 1989;153(5):997-1000.
Cubuk A, Yanaral F, Ozgor F, Savun M, Ozdemir H, Erbin A, et al. Comparison of 4.8 Fr and 6 Fr ureteral stents on stent related symptoms following ureterorenoscopy: A prospective randomized controlled trial. Kaohsiung J Med Sci. 2018;34(12):695-9.
Tanidir Y, Mangir N, Sahan A, Sulukaya M. Turkish version of the Ureteral Stent Symptoms Questionnaire: linguistic and psychometric validation. World journal of urology. 2017;35(7):1149-54.
Song T, Liao B, Zheng S, Wei Q. Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy. Urol Res. 2012;40(1):67-77.
Haleblian G, Kijvikai K, de la Rosette J, Preminger G. Ureteral stenting and urinary stone management: a systematic review. J Urol. 2008;179(2):424-30.
Piazzese EM, Mazzeo GI, Galipo S, Fiumara F, Canfora C, Angio LG. The renal resistive index as a predictor of acute hydronephrosis in patients with renal colic. J Ultrasound. 2012;15(4):239-46.
Norris CS, Pfeiffer JS, Rittgers SE, Barnes RW. Noninvasive evaluation of renal artery stenosis and renovascular resistance. Experimental and clinical studies. J Vasc Surg. 1984;1(1):192-201.
Patti G, Menghini ML, Todini AR, Marrocco G, Calisti A. The role of the renal resistive index ratio in diagnosing obstruction and in the follow-up of children with unilateral hydronephrosis. BJU Int. 2000;85(3):308-12.
Tanidir Y, Sahan A, Asutay MK, Sener TE, Talibzade F, Garayev A, et al. Differentiation of ureteral stones and phleboliths using Hounsfield units on computerized tomography: a new method without observer bias. Urolithiasis. 2017;45(3):323-8.
Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol. 2016;69(3):468-74.
Kilic S, Altinok MT, Ipek D, Beytur A, Baydinc YC, Gunes G. Color Doppler sonography examination of partially obstructed kidneys associated with ureteropelvic junction stone before and after percutaneous nephrolithotripsy: preliminary report. Int J Urol. 2005;12(5):429-35.
Klahr S, Pukerson ML. The pathophysiology of obstructive nephropathy: the role of vasoactive compounds in the hemodynamic and structural abnormalities of the obstructed kidney. Am J Kidney Dis. 1994;23(2):219-23.
Seklehner S, Sievert KD, Lee R, Engelhardt PF, Riedl C, Kunit T. A cost analysis of stenting in uncomplicated semirigid ureteroscopic stone removal. Int Urol Nephrol. 2017;49(5):753-61.
Ogreden E, Oguz U, Demirelli E, Benli E, Özen Ö.Ogreden E, et al. The impact of ureteral Double-J stent insertion following ureterorenoscopy in patients with ureteral stones accompanied by perirenal fat stranding. Arch Ital Urol Androl. 2018 Mar 31;90(1):15-19.
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