Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.

Comment in:

• J Endourol. 2009 Nov;23(11):1919.

Outcomes after treatment for urolithiasis vary greatly depending upon the imaging modality used to evaluate for residual stones. Commonly used modalities such as plain film “KUB”, renal ultrasound, and in the past, IVP can easily miss small residual fragments. Stone protocol abdominal CT scans are now used more often for the diagnosis and monitoring of patients with urolithiasis. All residual fragments after treatment including tiny, perhaps clinically insignificant fragments, are visualized using CT postoperatively. This is a nice study presenting their stone free rate following ureteroscopic treatment as determined by CT scan for follow-up. They present the results of 92 patients (113 ureteroscopies) for renal and ureteral stones. Stone free was determined by the strictest definition of no stone fragment on CT scan/ The overall stone free rate was 50.4% (80% for ureteral only, 34.8% for renal).

These results likely come as no surprise to most urologists. As the authors point out, the fate of these remaining fragments after ureteroscopy found on CT, most of them tiny, have not been specifically studied. There is no question that reporting of results after treatment for urolithiasis should be standardized, and include other outcomes such as quality of life measures. For now, it will have to suffice that the methods of postoperative imaging and definitions of success be clearly described in each study.

This randomized, placebo controlled trial assessed the usefulness of Alfuzosin (Uroxatrol) to control stent related symptoms after ureteroscopy. Patients were asked to complete the validated “Ureteral Stent Symptom Questionnaire” before and 3 days after ureteroscopy. Although the patients in the Alfuzosin arm reported less kidney pain during sleep, less frequent use of painkillers for kidney pain, and less interference with life from the kidney pain, the overall amount of narcotics used per day was no different.

A previous study using tamsulosin showed improvement in the “Ureteral Stent Symptom Questionnaire” and Qol scores.A comparison between the two medications might prove useful, as the autonomic effects of the two medications are different as evidenced by the different rates of ejaculatory dysfunction in a prior study.