ABSTRACT
Background: Urinary stones are the third most common affliction of urinary tract, exceeded only by urinary tract infections and pathological conditions of prostate (BPH and Prostate cancer). Extracorporeal Shock Wave Lithotripsy (ESWL) and Uretero-renoscopic Lithotripsy (URSL) are among various treatment options available. Aims and Objectives:To compare ESWLand URSLprocedural and post procedural characteristics including outcome. Methods: A Prospective study was conducted in the department of Urology, SKIMS, on 100 patients with proximal Ureteric stone, from September 2015 to July 2017.By random selection, fifty patients were subjected to ESWL and another fifty to URSL. Various parameters were recorded on preformed proforma designed for the comparative study. Results: In our study, Parameters like Age and Gender distribution, symptoms at presentation and duration of symptoms, number of stones, laterality of stones (right/left) and grade of Hydronephrosis or Hydroureteronephrosis were uniformly distributed in the two groups (URSL VS ESWL). Spinal anaesthesia (SA) or General Anaesthesia(GA) was required in URSL group only, while as local anaesthesia and sedation was required in some patients in ESWLgroup. 72% and 88% patients achieved stone clearance in ESWLand URSLgroup respectively, (p=0.046). DJ stent was used in 20% of URSL patients and none in ESWL group. Procedure time was relatively less for URSL (p=0.001). Although statistically insignificant, Post procedure hematuria and urosepsis were higher in URSL group, where as pain/colic and fever was slightly higher in ESWL group. Steinstrasse was significantly higher in ESWL group (p=0.008). Hospital stay was significantly higher in URSL group (p<0.001). Cost involvement was higher in ESWLgroup (p=0.016). Conclusion: Although ESWL is regarded as the preferred choice of treatment for upper Ureteric stone, URSL is a safe alternative, with an advantage of obtaining an earlier or immediate stone free status in patients with stone size >10mm. In patients with smaller stones (<10mm), ESWL may be considered a reasonable alternative to URSL.
ABSTRACT
Background: Laparoscopic Cholecystectomy in acute Cholecystitis is the established treatment of choice for the management of acute Cholecystitis. The conversion rate and morbidity is higher in Laparoscopic Cholecystectomy done in acute Cholecystitis. Aims and Objectives: To identify certain preoperative criteria for the selection of patients in acute Cholecystitis that can undergo laparoscopic Cholecystectomy, so that there is decrease in the conversion rate to open procedure and decrease in the complications. Methods: A Prospective interventional study was conducted in the Department of General Surgery, Moolchand Medcity, New Delhi, on 50 patients with acute Cholecystitis from September 2009 to September 2010. Data was analyzed using standard statistical software SPSS. Chi-square test was used for statistical analysis of qualitative data. Results: There were 4 males and 46 female patients with a mean age of 37. 74 years (range 18 to 65 years). There was no significant variation in intraoperative severity (IOS) pattern of acute Cholecystitis across the various age groups (p=0. 532). Males had significantly higher IOS grades of acute Cholecystitis as (p=0. 000). Among patients with varying IOS of acute Cholecystitis, there was significant difference in mean values of duration of symptoms before surgery (p=0.006), TLC at admission (adm.) (p=0.037) and at 24 hours of adm. (p=0.016) and serum AMS at adm. (p=0.005). The difference in mean serum ALP at adm. (p=0. 0171), at 24 hours of adm. (p=0. 137) and at 48 hours of adm. (p=0. 151), and mean values of TLC (p=0. 052) at 48 hours of adm. were insignificant across the various IOS grades of acute cholecystitis. There was no significant variation in histopathological severity (HPS) pattern of acute cholecystitis across the various age groups (p=0.826). Males had significantly higher HPS grades of acute Cholecystitis compared to females (p=0.042). Among patients with varying HPS of acute cholecystitis, there was no significant difference in mean duration of symptoms before surgery (p=0. 065). The difference in mean values of TLC at adm. (p=0.001), at 24 hours of adm. (p=0.001) and 48 hours of adm. (p=0.003); serum ALP at adm. (p=0.001), at 24 hours of adm.(p=0.001) and at 48 hours of adm.(p=0.022) was very significant across the various HPS grades of acute cholecystitis. The IOS (p=0.035) and HPS (p=0.032) of acute cholecystitis was significantly less with successful early lap Chole than with failed procedure. There was no significant difference in success versus failure rates of early Lap Chole across the age distribution of the patients (p=0. 153); mean values of duration of symptoms before surgery (p=0.971); TLC at adm. (p=0.422), at 24 hours of adm. (p=0.990) and at 48 hours of adm. (p=0. 478); serum ALP at adm. (p=0.113), at 24 hours of adm. (p=0.135) and at 48 hours of adm.(p= 0. 238). Male patients had significantly higher failure rate of early Lap Chole (p=0.022). Patients with failed early Lap Chole had a significantly longer mean duration of surgery (p=0. 032) and postoperative hospital stay (p=0.028) than those undergoing a successful procedure. Conclusion: Acute Cholecystitis is much more common in females. Severity of inflammation (intraoperative/ histopathological) in acute Cholecystitis is associated with higher failure/conversion rate of early laparoscopic Cholecystectomy because of dense pericholecystic adhesions, and has longer duration of surgery and postoperative hospital stay. This has a positive relation with male sex and TLC(IOS and TLC at 48 hrs of adm. , however had insignificant relation in our study ), while as no relation with age (at least up to 65 years) and mean duration of symptoms before surgery (if surgery is done within 1.5-4 days of onset of symptoms).