|
|
|
| Diagnostic value ultrasound signs of stones less than or equal to 10 mm and clinico-radiological variants of ureteric colic |
Denis V. Krakhotkina,*( ),Volodymyr A. Chernylovskyib,Kemal Saricac,Arman Tsaturyand,Evangelos Liatsikosd,e,f,Jurijus Makeviciusg,Nikolay Yu Iglovikovh,Dmitry N. Pikhovkini
|
a Central District Hospital, Outpatient Clinic, Sadovaya Lane 23, Kamenolomni, Rostov Region, Russia
b Private Urological Practice, Dnipro, Ukraine
c Department of Urology, Biruni University Hospital, Instanbul, Turkey
d Department of Urology, University Hospital of Patras, Patras, Greece
e Department of Urology, Medical University of Vienna, Vienna, Austria
f Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
g Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
h Department and Clinic of Urology, S.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia
i Central District Hospital, Department of Surgery, Lenina Avenue 28, Aksay, Rostov Region, Russia |
|
|
|
|
Abstract Objective: To determine the diagnostic value of ultrasound signs of urinary stones less than or equal to 10 mm and to determine clinico-radiological variants of ureteric colic. Methods: A total of 455 ultrasound investigations were performed in patients referring to emergency department with urolithiasis and symptoms suspected of ureteric colic between January 2021 and May 2021. In addition to microscopic evaluation of urine sediment to detect different crystals and non-contrast spiral computed tomography to detect stones, B-mode and color Doppler sonography was performed to assess the presence of acoustic shadow (AS) and twinkle artifacts (TA) as possible signs of stone(s) in ureter. Results: While the sensitivity and specificity of AS and TA were higher than 90% in patients with stones greater than 5 mm; positive prognostic values of these parameters were found to be extremely low for stones with sizes of 1-3 mm with specificity and sensitivity values not exceeding 53%. The sensitivity and specificity of AS and TA in the upper and lower ureters were higher for stones greater than or equal to 5 than for compared to those less than 5 mm. At the same time, the diagnostic values of TA and AS for middle ureter stones were very limited. The most prevalent clinico-radiological variants of ureteric colic were types I, III, and V being observed in 39%, 28% and 21% cases, respectively. Conclusion: Our results demonstrate that TA and AS parameters seem to have a very low sensitivity and specificity in the diagnosis of urinary stones less than 5 mm. The diagnostic value of TA and AS increase significantly in stones greater than or equal to 5 mm. Therefore, clinicians need to be very careful for overestimating the diagnostic values of TA and AS for stones less than 5 mm and non-contrast spiral computed tomography must be the method of choice for patients presenting to emergency department with ureteric colic.
|
|
Received: 13 December 2021
Available online: 20 January 2023
|
|
Corresponding Authors:
Denis V. Krakhotkin
E-mail: den_surgeon@mail.ru
|
|
|
| Characteristic | Value | | Age, mean±SD, year | 32.7±17.9 | | Body mass index, mean±SD, kg/m2 | 27.8±3.9 | | Gender, n (%) | | Male | 278 (61.1) | | Female | 177 (38.9) | | Comorbidity, n (%) | 52 (100) | | Type 2 diabetes mellitus | 18 (34.6) | | Obesitya | 15 (28.8) | | Osteoporosis | 5 (9.6) | | Arterial hypertension | 7 (13.5) | | Dyslipidemia | 4 (7.7) | | Gout | 3 (5.8) | | The side of ureteric colic, n (%) | | Right | 207 (45.5) | | Left | 245 (53.8) | | Bilateral | 3 (0.7) | | Stone localization, n (%) | | Upper ureter | 171 (37.6) | | Middle ureter | 152 (33.4) | | Lower ureter | 112 (24.6) | | Multifocal | 20 (4.4) | | Stone size, n (%) | | 1 mm | 16 (3.5) | | 2 mm | 21 (4.6) | | 3 mm | 33 (7.3) | | 4 mm | 44 (9.7) | | 5 mm | 60 (13.2) | | 6 mm | 51 (11.2) | | 7 mm | 57 (12.5) | | 8 mm | 52 (11.4) | | 9 mm | 62 (13.6) | | 10 mm | 59 (13.0) |
|
|
The demographic characteristics and computer tomography imaging results.
|
| Characteristic | Stone size (mm) | | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | | Acoustic shadow | | Sensitivity | 0.0 (0.0-84.2) | 33.3 (0.8-90.6) | 52.9 (27.8-77.0) | 52.5 (44.9-59.9) | 91.7 (87.4-94.9) | 95.1 (91.5-97.5) | 98.2 (95.5-99.5) | 99.1 (96.8-99.9) | 100.0 (98.4-100.0) | 100.0 (98.4-100.0) | | Specificity | 49.8 (45.1-54.5) | 49.9 (45.2-54.6) | 50.1 (45.3-54.9) | 51.7 (45.5-57.7) | 92.4 (88.1-95.5) | 94.3 (90.5-96.6) | 97.8 (94.9-99.2) | 98.7 (96.2-99.7) | 98.7 (96.2-99.7) | 100.0 (98.3-10.00) | | PPV | 0.0 (0.0-0.0) | 0.4 (0.1-2.1) | 3.9 (2.5-6.1) | 5.4 (4.5-6.4) | 92.5 (88.6-95.1) | 94.3 (90.7-96.6) | 97.8 (94.9-99.1) | 98.7 (96.1-99.6) | 98.7 (96.1-99.6) | 99.5 (97.6-99.9) | | NPV | 99.1 (99.0-99.2) | 99.1 (98.1-99.6) | 96.5 (94.2-97.8) | 95.4 (94.5-96.1) | 91.6 (87.7-94.4) | 95.2 (91.7-97.2) | 98.2 (95.5-99.3) | 99.1 (96.6-99.8) | 100.0 (98.7-100.0) | 100.0 (98.3-100.0) | | Accuracy | 49.6 (44.9-54.3) | 49.8 (45.1-54.5) | 50.2 (45.5-54.9) | 51.7 (47.0-56.4) | 92.0 (89.2-94.4) | 94.7 (92.3-96.6) | 98.0 (96.2-99.1) | 98.9 (97.5-99.6) | 99.3 (98.1-99.8) | 99.7 (98.8-99.9) | | Twinkle artifact | | Sensitivity | 0.0 (0.0-97.5) | 47.1 (22.9-72.2) | 52.8 (35.5-69.6) | 85.7 (80.0-90.2) | 89.4 (84.6-93.1) | 93.3 (89.2-96.2) | 94.6 (90.8-97.2) | 96.4 (93.1-98.5) | 98.7 (96.2-99.7) | 99.1 (96.9-99.9) | | Specificity | 49.9 (45.2-54.6) | 49.9 (45.1-54.7) | 51.1 (46.2-55.9) | 77.1 (71.5-82.1) | 89.0 (84.2-92.8) | 91.8 (87.5-95.0) | 92.7(88.6-95.7) | 95.6 (92.1-97.9) | 98.2 (95.6-99.5) | 99.5 (97.6-99.9) | | PPV | 0.0 (0.0-0.0) | 3.5 (2.1-5.7) | 8.4 (6.2-11.2) | 74.0 (69.3-78.2) | 88.9 (84.8-92.1) | 91.6 (87.7-94.4) | 92.5 (88.7-95.1) | 95.6 (92.2-97.6) | 98.2 (95.5-99.3) | 99.5 (96.9-99.9) | | NPV | 99.6 (99.5-99.6) | 96.0 (93.9-97.4) | 92.7 (89.9-94.8) | 87.6 (83.3-90.9) | 89.4 (85.2-92.5) | 93.4 (89.7-95.9) | 94.7 (91.2-96.9) | 96.5 (93.3-98.2) | 98.7 (96.0-99.6) | 99.1 (96.6-99.8) | | Accuracy | 49.8 (45.1-54.5) | 49.8 (45.1-54.5) | 51.2 (46.5-55.8) | 80.8 (76.9-84.3) | 89.2 (85.9-91.9) | 92.5 (89.7-94.8) | 93.6 (90.9-95.7) | 96.0 (93.8-97.6) | 98.5 (96.6-99.4) | 99.3 (98.1-99.8) |
|
|
Sensitivity (%), specificity (%), PPV (%), NPV (%), and accuracy (%) of ultrasound signs of urinary stone (acoustic shadow and twinkle artifact).
|
|
|
Graphical display of the dependence of the value (95% confidence interval) of TA and AS in percentage of the size of the stone. (A) Sensitivity; (B) Specificity; (C) Positive prognostic value; (D) Negative prognostic value; (E) Accuracy. TA, twinkle artifact; AS, acoustic shadow.
|
| Variable | VAS 8-10 | Maximum extension of the renal pelvis | | OR | 95 % CI | p-Value | OR | 95 % CI | p-Value | | Twinkle artifact in US | 1.018 | 0.966-1.073 | 0.032 | 0.024 | 0.002-0.259 | 0.021 | | Acoustic shadow in US | 0.916 | 0.857-0.978 | 0.010 | 5.310 | 1.711-16.48 | 0.024 | | Kidney stone | | | | | | | | ≥5 mm | 0.864 | 0.764-0.976 | 0.020 | 0.083 | 0.059-19.65 | 0.308 | | <5 mm | 1.084 | 0.930-1.263 | 0.307 | 2.846 | 0.908-8.922 | 0.059 | | Ureter stone | | <5 mm | 1.065 | 0.917-1.237 | 0.409 | 1.249 | 0.976-1.600 | 0.077 | | ≥5 mm | 1.157 | 1.012-1.323 | 0.036 | 0.841 | 0.720-0.983 | 0.029 | | Microhematuria | 0.973 | 0.930-1.018 | 0.237 | 1.497 | 1.212-1.850 | 0.014 | | Macrohematuria | 1.000 | 0.996-1.004 | 0.972 | 0.975 | 0.952-0.998 | 0.043 | | Calcium oxalate dihydrate | 0.859 | 0.754-0.978 | 0.023 | 0.913 | 0.730-1.141 | 0.041 | | Triple phosphate (NH4MgPO4) and calcium phosphates | 0.949 | 0.824-1.092 | 0.463 | 1.412 | 0.288-6.932 | 0.647 | | Amorphous urates | 1.185 | 1.029-1.365 | 0.020 | 0.586 | 0.341-1.005 | 0.069 |
|
|
Multivariable logistic regression analysis for risk factors associated with maximal value of pain (VAS 8-10) and the degree of maximum extension of the renal pelvis.
|
| Part of ureter | Diagnostic value of acoustic shadow | Diagnostic value of twinkle artifact | | Upper ureter | -
Sensitivity
<5 mm: 0%-57.8%;
≥5 mm: 91.7%-99.7%
-
Specificity
<5 mm: 48.9%-53.7%;
≥5 mm: 93.4%-99.8%
-
Positive prognostic value
<5 mm: 0%-5.4%;
≥5 mm: 92.5%-99.8%
-
Negative prognostic value
<5 mm: 98.1%-99.6%;
≥5 mm: 98.7%-99.7%
-
Accuracy
<5 mm: 48.2%-52.9%;
≥5 mm: 92.9%-99.8% | -
Sensitivity
<5 mm: 0%-86.8%;
≥5 mm: 97.8%-99.9%
-
Specificity
<5 mm: 45.4%-69.9%;
≥5 mm: 96.4%-99.8%
-
Positive prognostic value
<5 mm: 0%-75.4%;
≥5 mm: 97.5%-99.9%
-
Negative prognostic value
<5 mm: 98.7%-99.8%;
≥5 mm: 99.1%-99.9%
-
Accuracy
<5 mm: 46.1%-72.9%;
≥5 mm: 97.9%-99.9% | | Middle ureter | -
Sensitivity
<5 mm: 0%-37.8%;
≥5 mm: 45.6%-53.2%
-
Specificity
<5 mm: 37.9%-48.7%;
≥5 mm: 41.4%-51.8%
-
Positive prognostic value
<5 mm: 0%-4.8%;
≥5 mm: 43.5%-50.8%
-
Negative prognostic value
<5 mm: 98.7%-99.8%;
≥5 mm: 99.1%-99.9%
-
Accuracy
<5 mm: 0%-39.8%;
≥5 mm: 35.9-49.8% | -
Sensitivity
<5 mm: 0%-47.8%;
≥5 mm: 48.9%-65.7%
-
Specificity
<5 mm: 48.9%-53.7%;
≥5 mm: 49.4%-59.8%
-
Positive prognostic value
<5 mm: 0%-25.4%;
≥5 mm: 44.6%-62.4%
-
Negative prognostic value
<5 mm: 99.2%-99.9%;
≥5 mm: 98.9%-99.9%
-
Accuracy
<5 mm: 48.2%-60.9%;
≥5 mm: 50.9%-63.5% | | Lower ureter | -
Sensitivity
<5 mm: 0%-53.8%;
≥5 mm: 95.6-99.9%
-
Specificity
<5 mm: 45.8%-54.5%;
≥5 mm: 94.8%-99.9%
-
Positive prognostic value
<5 mm: 0%-4.6%;
≥5 mm 96.5%-99.9%
-
Negative prognostic value
<5 mm 98.7%-99.8%;
≥5 mm: 99.1%-99.8%
-
Accuracy
<5 mm: 45.3%-50.8%;
≥5 mm: 95.4%-99.9% | -
Sensitivity
<5 mm: 0%-79.8%;
≥5 mm: 91.7%-99.7%
-
Specificity
<5 mm: 44.9%-63.7%;
≥5 mm: 97.9%-99.9%
-
Positive prognostic value
<5 mm: 0%-5.1%;
≥5 mm: 96.5%-99.9%
-
Negative prognostic value
<5 mm: 99.3%-99.8%;
≥5 mm: 99.3%-99.9%
-
Accuracy
<5 mm: 46.3%-59.8%;
≥5 mm: 96.9%-99.9% |
|
|
Diagnostic value of ultrasound signs of stones (≤10 mm) in upper, middle, and lower ureter.
|
|
|
CRV I. (A) The presence of urinary stone in computer tomography scan in axial plane; (B) Ultrasound image of urinary stone with clear acoustic shadow; (C) Ultrasound image of urinary stone with clear twinkle artifact; (D) Microscopic image of crystals of different salts in urine sediment (magnification 400×); (E) Graphical display of the wavy dependence of the pain level measured with VAS and duration of ureteric colic in minutes; (F) Graphical display of the rectilinear dependence of the pain level measured with VAS and duration of ureteric colic in minutes; (G) Graphical display of the wavy dependence of renal pelvis extension level (cm) and duration of ureteric colic in minutes; (H) The maximum extension of the renal pelvis at 30 min of ureteric colic; (I) The maximum extension of the renal pelvis at 120 min of ureteric colic; (J) Graphical display of the rectilinear dependence of renal pelvis extension level (cm) and duration of ureteric colic in minutes; (K) The maximum extension of the renal pelvis at 60 min of ureteric colic; (L) The maximum extension of the renal pelvis at 240 min of ureteric colic. VAS, visual analogue scale; CRV, clinico-radiological variant of ureteric colic; CRV I, CRV type I; CRV Ia, CRV type Ia; CRV Ib, CRV type Ib.
|
|
|
CRV II. (A) The absence of urinary stone in computer tomography scan; (B) Ultrasound image of urinary stone without acoustic shadow and twinkle artifact; (C, D) Microscopic images of crystals of different salts in urine sediment (magnification 400×); (E) Graphical display of the dependence of the pain level measured with VAS and duration of ureteric colic in minutes; (F) Graphical display of the dependence of the maximum extension of the renal pelvis and duration of ureteric colic in minutes; (G) The maximum extension of the renal pelvis at 15 min of ureteric colic; (H) The maximum extension of the renal pelvis at 30 min of ureteric colic. VAS, visual analogue scale; CRV II, clinico-radiological variant of ureteric colic type II.
|
|
|
CRV III. (A) The presence of urinary stone in computer tomography scan in frontal plane; (B) Ultrasound image of urinary stone without acoustic shadow and twinkle artifact; (C, D) Microscopic images of crystals of different salts in urine sediment (magnification 400×); (E) Graphical display of the dependence of the pain level measured with VAS and duration of ureteric colic in minutes; (F) Graphical display of the dependence of the maximum extension of the renal pelvis and duration of ureteric colic in minutes; (G) The maximum extension of the renal pelvis at 5 min of ureteric colic; (H) The maximum extension of the renal pelvis at 30 min of ureteric colic. VAS, visual analogue scale; CRV III, clinico-radiological variant of ureteric colic type III.
|
|
|
CRV IV. (A) The presence of urinary stone in computer tomography scan in frontal plane; (B) Ultrasound image of urinary stone without acoustic shadow and twinkle artifact; (C) Graphical display of the dependence of the pain level measured with VAS and duration of ureteric colic in minutes; (D) Graphical display of the maximum extension of the renal pelvis and duration of ureteric colic in minutes; (E) The maximum extension of the renal pelvis at 5 min of ureteric colic; (F) The maximum extension of the renal pelvis at 30 min of ureteric colic. VAS, visual analogue scale; CRV IV, clinico-radiological variant of ureteric colic type IV.
|
|
|
CRV V. (A) The presence of urinary stone in computer tomography scan in axial plane; (B) Ultrasound image of urinary stone with clear acoustic shadow; (C) Ultrasound image of urinary stone with clear twinkle artifact; (D) The computer tomography scan of urinary stone in frontal plane; (E) Graphical display of the wavy dependence of the pain level measured with VAS and duration of ureteric colic in minutes; (F) Graphical display of the rectilinear dependence of the pain level measured with VAS and duration of ureteric colic in minutes; (G) Graphical display of the wavy dependence of renal pelvis extension level (cm) and duration of ureteric colic in minutes; (H) The maximum extension of the renal pelvis at 120 min of ureteric colic; (I) The maximum extension of the renal pelvis at 30 min of ureteric colic; (J) Graphical display of the rectilinear dependence of renal pelvis extension level (cm) and duration of ureteric colic in minutes; (K) The maximum extension of the renal pelvis at 60 min of ureteric colic; (L) The maximum extension of the renal pelvis at 120 min of ureteric colic. VAS, visual analogue scale; CRV, clinico-radiological variant of ureteric colic; CRV V, CRV type V; CRV Va, CRV type Va; CRV Vb, CRV type Vb.
|
| [1] |
Corbo J, Wang J. Kidney and ureteral stones. Emerg Med Clin 2009; 37:637e48.
|
| [2] |
Curhan GC. Epidemiology of stone disease. Urol Clin 2007; 34: 287e93.
|
| [3] |
Moore CL, Carpenter CR, Heilbrun ML, Klauer K, Krambeck AC, Moreno C, et al. Imaging in suspected renal colic: systematic review of the literature and multispecialty consensus. J Urol 2019; 202:475e83.
doi: 10.1097/JU.0000000000000342
pmid: 31412438
|
| [4] |
Brisbane W, Bailey MR, Sorensen MD. An overview of kidney stone imaging techniques. Nat Rev Urol 2016; 13:654e62.
doi: 10.1038/nrurol.2016.154
pmid: 27578040
|
| [5] |
Lazar M, Ringl H, Baltzer P, Toth D, Seitz C, Krauss B, et al. Protocol analysis of dual-energy CT for optimization of kidney stone detection in virtual non-contrast reconstructions. Eur Radiol 2020; 30:4295e305.
doi: 10.1007/s00330-020-06806-9
pmid: 32242275
|
| [6] |
Lim GS, Jang SH, Son JH, Lee JW, Hwang JS, Lim CH, et al. Comparison of non-contrast-enhanced computed tomography and intravenous pyelogram for detection of patients with urinary calculi. Korean J Urol 2014; 55:120e3.
doi: 10.4111/kju.2014.55.2.120
pmid: 24578808
|
| [7] |
Tzou DT, Usawachintachit M, Taguchi K, Chi T. Ultrasound use in urinary stones: adapting old technology for a modern-day disease. J Endourol 2017; 31:89e94.
doi: 10.1089/end.2016.0584
pmid: 27733052
|
| [8] |
Passerotti C, Chow JS, Silva A, Schoettler CL, Rosoklija I, Perez-Rossello J, et al. Ultrasound versus computerized to-mography for evaluating urolithiasis. J Urol 2009; 182:1829e34.
doi: 10.1016/j.juro.2009.03.072
pmid: 19692054
|
| [9] |
Bari V. Direct observation of procedural skills in radiology. AJR Am J Roentgenol 2010; 195:14e8.
|
| [10] |
Gulati M, Cheng J, Loo JT, Skalski M, Malhi H, Duddalwar V. Pictorial review: renal ultrasound. Clin Imag 2018; 51:133e54.
doi: S0899-7071(18)30043-3
pmid: 29477809
|
| [11] |
Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA, Corbo J, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med 2014; 371:1100e10.
doi: 10.1056/NEJMoa1404446
|
| [12] |
Rahmouni A, Bargoin R, Herment A, Bargoin N, Vasile N. Color Doppler twinkling artifact in hyperechoic regions. Radiology 1996; 199:269e71.
doi: 10.1148/radiology.199.1.8633158
pmid: 8633158
|
| [13] |
Korkmaz M, Aras B, Sanal B, Yücel M, Güneyli S, Ko?ak A, et al. Investigating the clinical signi?cance of twinkling artifacts in patients with urolithiasis smaller than 5 mm. Jpn J Radiol 2014; 32:482e6.
|
| [14] |
Gliga ML, Chirila CN, Podeanu DM, Imola T, Voicu SL, Gliga MG, et al. Twinkle, twinkle little stone: an artifact improves the ultrasound performance. Med Ultrason 2017; 19:272e5.
|
| [15] |
Abdel-Gawad M, Kadasne RD, Elsobky E, Ali-El-Dein B, Monga M. A prospective comparative study of color Doppler ultrasound with twinkling and noncontrast computerized to-mography for the evaluation of acute renal colic. J Urol 2016; 196:757e62.
doi: 10.1016/j.juro.2016.03.175
pmid: 27063853
|
| [16] |
Masch WR, Cohan RH, Ellis JH, Dillman JR, Rubin JM, Davenport MS. Clinical effectiveness of prospectively reported sonographic twinkling artifact for the diagnosis of renal cal-culus in patients without known urolithiasis. AJR Am J Roentgenol 2016; 206:326e31.
doi: 10.2214/AJR.15.14998
|
| [17] |
Puttmann K, Dajusta D, Rehfuss AW. Does twinkle artifact truly represent a kidney stone on renal ultrasound? J Pediatr Urol 2021; 17:475e6.
|
| [18] |
Dai JC, Dunmire B, Sternberg KM, Liu Z, Larson T, Thiel J, et al. Retrospective comparison of measured stone size and posterior acoustic shadow width in clinical ultrasound images. World J Urol 2018; 36:727e32.
doi: 10.1007/s00345-017-2156-8
pmid: 29243111
|
| [19] |
Durr-E-Sabih A, Khan AN, Craig M, Worrall JA. Sonographic mimics of renal calculi. J Ultrasound Med 2004; 23:1361e7.
pmid: 15448326
|
| [20] |
Fazil Marickar YM, Salim A, Vijay A. Stone symptoms and uri-nary deposits. Urol Res 2010; 38:65e9.
doi: 10.1007/s00240-009-0227-z
pmid: 19888570
|
| [21] |
Fan J, Chandhoke PS. Examination of crystalluria in freshly voided urines of recurrent calcium stone formers and normal individuals using a new ?lter technique. J Urol 1999; 161: 1685e8.
pmid: 10210440
|
| [22] |
Tamo?aityté S, Hendrixson V, ?elvys A, Tyla R, Ku?inskiené ZA, Jankevi?ius F, et al. Combined studies of chemical composi-tion of urine sediments and kidney stones by means of infrared microspectroscopy. J Biomed Opt 2013; 18: 27011.
doi: 10.1117/1.JBO.18.2.027011
|
| [23] |
Hsi RS, Dunmire B, Cunitz BW, He X, Sorensen MD, Harper JD, et al. Content and face validation of a curriculum for ultra-sonic propulsion of calculi in a human renal model. J Endourol 2014; 28:459e63.
doi: 10.1089/end.2013.0589
|
| [1] |
Kelly Lehner,Catherine Ingram,Utsav Bansal,Colleen Baca,Adithya Balasubramanian,Nannan Thirumavalavan,Jason M. Scovell,Saneal Rajanahally,Matthew Pollard,Larry I. Lipshultz. Color Doppler ultrasound imaging in varicoceles: Is the difference in venous diameter encountered during Valsalva predictive of palpable varicocele grade?[J]. Asian Journal of Urology, 2023, 10(1): 27-32. |
| [2] |
. Reliability of nephrolithometric nomograms in patients treated with minimally invasive percutaneous nephrolithotomy: A precision study[J]. Asian Journal of Urology, 2023, 10(1): 70-80. |
| [3] |
Jiefeng Xiao,Shukai Zheng,Zhaolong Qiu,Kusheng Wu. Associations between IL-1RN variable number of tandem repeat, IL-1β (-511) and IL-1β (+3954) gene polymorphisms and urolithiasis in Uighur children of China[J]. Asian Journal of Urology, 2022, 9(1): 51-56. |
| [4] |
Omran Hasan,Mohamed Mubarak,S. Mohamed Jawad Alwedaie,Hasan Baksh,Husain Alaradi,Ameer Alarayedh,Ali Alaradi,Abdolsalam Ahmadi,Akbar Jalal. Ultrasound heterogeneity as an indicator of testicular salvage in testicular torsion: A single center experience[J]. Asian Journal of Urology, 2022, 9(1): 57-62. |
| [5] |
Dilip K. Mishra,Sonia Bhatt,Sundaram Palaniappan,Talamanchi V.K. Reddy,Vinothkumar Rajenthiran,Y.L. Sreeranga,Madhu S. Agrawal. Mini versus ultra-mini percutaneous nephrolithotomy in a paediatric population[J]. Asian Journal of Urology, 2022, 9(1): 75-80. |
| [6] |
Yiwei Wang, Liheng Gao, Mingxi Xu, Wenfeng Li, Yuanshen Mao, Fujun Wang, Lu Wang, Jun Da, Zhong Wang. A novel spherical-headed fascial dilator is feasible for second-stage ultrasound guided percutaneous nephrolithotomy: A pilot study[J]. Asian Journal of Urology, 2021, 8(4): 424-429. |
| [7] |
Russell S. Terry,Glenn M. Preminger. Metabolic evaluation and medical management of staghorn calculi[J]. Asian Journal of Urology, 2020, 7(2): 122-129. |
| [8] |
Osman Ermis,Bhaskar Somani,Thomas Reeves,Selcuk Guven,Pilar Laguna Pes,Arun Chawla,Padmaraj Hegde,Jean de la Rosette. Definition, treatment and outcome of residual fragments in staghorn stones[J]. Asian Journal of Urology, 2020, 7(2): 116-121. |
| [9] |
Nariman Gadzhiev,Vigen Malkhasyan,Gagik Akopyan,Sergei Petrov,Francis Jefferson,Zhamshid Okhunov. Percutaneous nephrolithotomy for staghorn calculi: Troubleshooting and managing complications[J]. Asian Journal of Urology, 2020, 7(2): 139-148. |
| [10] |
Bohdan Baralo,Patrick Samson,David Hoenig,Arthur Smith. Percutaneous kidney stone surgery and radiation exposure: A review[J]. Asian Journal of Urology, 2020, 7(1): 10-17. |
| [11] |
Siddharth Pandey,Tanica Pandey,Apul Goel,Ajay Aggarwal,Deepanshu Sharma,Tushar Pandey,Satya sankhwar,Gaurav Garg. Utility of trans-vaginal ultrasound in diagnosis and follow-up of non-pregnant sexually active females with lower ureteric calculi[J]. Asian Journal of Urology, 2020, 7(1): 45-50. |
| [12] |
Liu Yu,Chen Yuntian,Liao Banghua,Luo Deyi,Wang Kunjie,Li Hong,Zeng Guohua. Epidemiology of urolithiasis in Asia[J]. Asian Journal of Urology, 2018, 5(4): 205-214. |
| [13] |
Carter Boyd,Kyle Wood,Dustin Whitaker,Dean G. Assimos. The influence of metabolic syndrome and its components on the development of nephrolithiasis[J]. Asian Journal of Urology, 2018, 5(4): 215-222. |
| [14] |
Jennifer Bjazevic,Hassan Razvi*. Stones in pregnancy and pediatrics[J]. Asian Journal of Urology, 2018, 5(4): 223-234. |
| [15] |
Matthias Beysens,Thomas O. Tailly. Ureteral stents in urolithiasis[J]. Asian Journal of Urology, 2018, 5(4): 274-286. |
|
|
|
|
