Extracorporeal shock wave lithotripsy

To determine the outcome of patients undergoing extracorporeal shock wave lithotripsy [ESWL] for treatment of upper urinary tract calculi [renal and ureteric], and to note role of double-J [DJ] stents in these patients. A cross-sectional analytical study. Department of Urology, Rawalpindi General Hospital, Rawalpindi, from February 1999 to July 2001. Record of patients who underwent ESWL for renal and ureteric stones was retrieved and analyzed using statistical program, SPSS version-10 and Epi-Info 2000. In some patients pre-ESWL DJ stents were placed because of various reasons like solitary kidney, large stone volume etc. Patients were divided in two groups, Group I, in whom DJ stents were not placed, and Group II, in whom DJ stents were placed. ESWL was performed in each subject in standard way employing piezoelectric lithotripter E.D.A.P. LT 02X. Patients were evaluated for stone clearance fortnightly with X-ray or ultrasound. Four hundred and thirty-two patients, 68.8% male and 31.2% female, underwent ESWL. Mean age of patients was 37.7 ' 13.1 years. Majority of patients [78.47%, n=339] had renal, while rest had ureteric stones. Group I and II included 408 [94.4%] and 24 [5.6%] patients respectively. Renal stones were present in 78% [n=318] of Group I and 87.5% [n=21] of Group II patients. Mean size of stones in Group I and II patients was 10.91 ' 4.6, and 10.4 ' 4.7mm. Stone clearance was 96.3% and 100% in Group I and Group II patients respectively. Significantly more ESWL sessions were required for stone clearance in Group II [p-value 0.03]; in addition Group II patients had significantly more complications [p-value 0.01]. ESWL is an effective procedure. Pre-ESWL stenting is associated with increased numbers of ESWL sessions and more complications

Endoscopic retrograde cholangiopancreatographic evaluation of patients with obstructive jaundice

To evaluate the role of endoscopic retrograde cholangiopancreatography [ERCP] in patients with obstructive jaundice. Design: A retrospective, observational study. Place and Duration of Study: The study was carried out at Valley Clinic, Rawalpindi, from January 1999 to January 2002. Subjects and Two-hundred and twenty-six patients, who underwent ERCP for evaluation of obstructive jaundice were included. ERCP in each case was performed with standard technique and the findings were recorded. Therapeutic procedures like sphincterotomy, Dormia extraction for stone, and stent placements were performed whenever indicated. Of the 226 patients, 117 [51.8%] were males, and 109 [48.2%] females, their mean age being 51.8 ' 16.6 years. Common bile and pancreatic ducts were visualized in 81.8% and 68.1% patients respectively. Growth/masses and stones were commonest causes of obstructive jaundice. Choledocholithias was common in males, while biliary channel related growth/masses were common in females [p-value = 0.03]. Common bile duct stone clearance rate was 88%, stenting was highly successful in patients with growth and strictures. ERCP related complications were noted in 11 [4.8%] patients. ERCP is an important diagnostic and therapeutic modality for evaluation of patients with obstructive jaundice. Growth/masses and stones are common causes of obstructive jaundice which can be diagnosed and treated with ERCP