TY - JOUR
T1 - The Peak Site of Stone Distribution in the Upper Ureter is Unlikely the Ureteropelvic Junction
T2 - Computed Tomography Analysis of Stone Lodging Site With Respect to a Newly Identified Area of Constriction
AU - Kamo, Minobu
AU - Nozaki, Taiki
AU - Starkey, Jay
AU - Horiuchi, Saya
AU - Muraishi, Natsuka
AU - Hattori, Kazunori
AU - Akita, Keiichi
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/9
Y1 - 2017/9
N2 - Objective To investigate the relationship between the upper urinary stone distribution and the “crossing point,” an area of relative fixation within the upper ureter at approximately the level where the ureter crosses the gonadal vein. Materials and Methods We reviewed 298 consecutive patients presenting with acute renal colic, identified upper ureteral stones in computed tomography. For stones located at the “renal pelvis and upper ureter,” we measured the vertebral level of each renal pelvis, crossing point, and stone. The distance between the crossing point and the stones (designated as positive if the stone was located above it) and the distance between the renal pelvis and the crossing point were measured. Results The average stone size at the “renal pelvis and upper ureter” was 6.0 ± 3.2 mm, at “middle ureter” 5.2 ± 1.9 mm, and at “lower ureter” 3.7 ± 1.8 mm. Lower location was significantly correlated with smaller size (P <.001). The level of the crossing point and stone location were significantly lower on the right (P =.019, P =.033, respectively), whereas the vertebral level of the renal pelvis was not significantly different on both sides (P =.225). The mean distance between the crossing point and the stones was −5.6 ± 18.4 mm (median: 0 mm) on the right and −4.7 ± 19.3 mm (median: 0 mm) on the left. The mean distance between the renal pelvis and the stones was significantly longer on the right (57.2 ± 18.5 mm and 48.2 ± 19.1 mm) (P =.038). Conclusion The crossing point is the peak site of stone distribution in the upper ureter and likely different from the traditionally identified obstruction site at the ureteropelvic junction.
AB - Objective To investigate the relationship between the upper urinary stone distribution and the “crossing point,” an area of relative fixation within the upper ureter at approximately the level where the ureter crosses the gonadal vein. Materials and Methods We reviewed 298 consecutive patients presenting with acute renal colic, identified upper ureteral stones in computed tomography. For stones located at the “renal pelvis and upper ureter,” we measured the vertebral level of each renal pelvis, crossing point, and stone. The distance between the crossing point and the stones (designated as positive if the stone was located above it) and the distance between the renal pelvis and the crossing point were measured. Results The average stone size at the “renal pelvis and upper ureter” was 6.0 ± 3.2 mm, at “middle ureter” 5.2 ± 1.9 mm, and at “lower ureter” 3.7 ± 1.8 mm. Lower location was significantly correlated with smaller size (P <.001). The level of the crossing point and stone location were significantly lower on the right (P =.019, P =.033, respectively), whereas the vertebral level of the renal pelvis was not significantly different on both sides (P =.225). The mean distance between the crossing point and the stones was −5.6 ± 18.4 mm (median: 0 mm) on the right and −4.7 ± 19.3 mm (median: 0 mm) on the left. The mean distance between the renal pelvis and the stones was significantly longer on the right (57.2 ± 18.5 mm and 48.2 ± 19.1 mm) (P =.038). Conclusion The crossing point is the peak site of stone distribution in the upper ureter and likely different from the traditionally identified obstruction site at the ureteropelvic junction.
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U2 - 10.1016/j.urology.2017.05.045
DO - 10.1016/j.urology.2017.05.045
M3 - Article
C2 - 28595936
AN - SCOPUS:85026640154
SN - 0090-4295
VL - 107
SP - 31
EP - 36
JO - Urology
JF - Urology
ER -