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.

Hermans T, Sauerman P, Rufibach K, Frauenfelder T, Sulser T, and Strebel RT

A recent randomized double blinded study that did not show different rate of successful stone passage for Tamsulosin vs. placebo (86.7% vs 88.9%), but the Tamsolosin group did pass their stones earlier (7 d vs. 10 d on average) and required less pain medications. It is quite possible that the advantage of the use of alpha blockers relates less to an improved ability to pass the stones, but rather less pain, and therefore more likely to tolerate the time required to pass the stone.