Title: A comparative analysis between stented and non-stented techniques in extracorporeal shock wave lithotripsy for upper ureteral stones.
Abstract: INTRODUCTION : The goal of treating ureteral calculi is to achieve complete stone clearance with minimal morbidity for the patient. The factors that must be considered when recommending treatment to patients with ureteric calculi may be grouped into three broad categories: stone-related factors (location, size, composition, duration, and degree of obstruction), clinical factors (the patient's tolerance of symptomatic events, the patient's expectation, associated infection, solitary kidney, abnormal ureteric anatomy, and technical factors (equipment available for treatment, costs). These factors may be thought of as treatment modifiers. Nevertheless, several surgical options are available for proximal ureteral calculi. Advances in ureteroscope design, newer methods of intracorporeal stone fragmentation, laparoscopic techniques and ongoing developments in extracorporeal shock wave lithotripsy have resulted in changes with regard to the use of treatment modalities for ureteral stones. Extracorporeal shock wave lithotripsy (ESWL) is the least invasive treatment for calculi of the upper urinary tract and it is recommended as first line therapy. However, ESWL has a variable success rate for large upper ureteral calculi. The density of stone measured by NCCT, stone Hounsfield Unit (HU) varies with stone composition and determines the fragility of a calculus which ultimately governs the clinical outcome in
ESWL. NCCT because of its easy availability, excellent sensitivity and very high resolution capability is a good modality for the measurement of stone density. AIM : The aim of this study is: 1. To identify the effect of the presence of a ureteric stent on the outcome of extracorporeal shockwave lithotripsy (ESWL), by comparing patients with ureteric stones with matched-pair analysis. 2. To find out complications of extracorporeal shock wave lithotripsy during the management of upper ureteric calculus. MATERIALS AND METHODS : All the patients were explained about the available modalities of treatments and their complications in the management of upper ureteric calculus – Medical Expulsion Therapy, Ureteroscopy with Intracorporeal Lithotripsy, Extracorporeal Lithotripsy, Percutaneous Nephrolithotomy and Open Surgery. A detailed history and a clinical examination was performed followed by baseline investigations including complete blood count, blood sugar, urea, serum creatinine, urine routine including culture
and sensitivity were done in all patients. A plain X ray KUB and Ultrasound were done in all patients. Either Intravenous Urogram or Contrast Enhanced CT KUB was done as a functional study. Stone size measurements taken in the study – largest dimension in plain X ray KUB and Ultrasound. CONCLUSION : Treatment with ESWL has a low morbidity and high effectiveness. Pre ESWL ureteral stenting provides no additional benefit over in situ ESWL. Uretral stents are associated with significant patient discomfort and morbidity. Although ureteral stents are associated with more irritative symptoms, their use resulted in fewer hospital readmissions compared to when no stent was used to treat upper ureteric calculus.
Publication Year: 2011
Publication Date: 2011-08-01
Language: en
Type: dissertation
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