ABSTRACT
Introduction: Extracorporeal shock-wave lithotripsy (ESWL)is an established non-invasive treatment modality for renaland ureteric stones. However, treatment outcome and efficacydepends on multiple factors like stone size, location and typeof machine used. We aimed to assess efficacy of ESWL asa primary treatment modality in renal and ureteric stones ina busy hospital setting having significant renal stone diseaseburden.Material and methods:1187 patients who underwent ESWLbetween January 2015 to December 2016 in our departmentwere included in the study. Patients with nephrolithiasis andureterolithiasis having functional kidney, without any absolutecontraindication to ESWL were included. Dornier Med TechCompact Delta 2 machines were used for all the patients.Stone localization was done using both fluoroscopic andultrasound- guided methods by same expert.Results: Out of 1187 patients,887 patients had solitary renalstones,170 had solitary ureteral calculus and 130 patients hadmultiple renal calculi. Stone size ranged from 8mm–20mm.Renal pelvic stones, upper calycial stones and proximalureteric stones had stone free rate of 84%,86% and 82.5%respectively. 89% and 84% of patients were stone free whensize of stone was between 8-12mm, it decreased to 77% and73% when size increased between 13-16mm for kidney andureteric stones respectively.Conclusions: ESWL is an effective primary treatmentmodality for appropriately selected patients with stone sizeless than 2 cm in favorable location with a normal functioningkidney. Use of both fluoroscopic and ultrasound imagingimproves localization of stones thus improving success. Itis an important modality in hands of urologist treating hugevolume of urolithiasis patients in busy hospitals with longwaiting list and with limited resources.
ABSTRACT
Background: Urological disorders like stone disease, pyonephrosis secondary to obstruction and trauma are common during pregnancy with global incidence of 1 in 250 to 1 in 3000. These diseases can complicate any pregnancy and timely diagnosis and management is of utmost importance for safety of the mother and fetus. Managing these cases entails morbidity and minimally invasive procedures avoiding anesthesia have definite advantage.Methods: It was an observational study. Pregnant patients with nephrolithiasis, pyonephrosis, complicated post-traumatic ureteropelvic junction (PUJ) obstruction (PUJO) and trauma were included in the study.Results: Out of total 84 cases, 45 required intervention. Percutaneous nephrostomy (PCN) for pyonephrosis secondary to PUJO and obstructed PUJ calculus was done in 11 and 14 cases respectively. Bilateral PCN for bilateral nephrolithiasis was done in 7 cases. Silicon double-J stenting for ureteric calculus was done in 13 cases. One case of spontaneous fornicial rupture of kidney without stone disease was managed conservatively as were 4 cases of trauma with concomitant renal injury, 18 cases of non-obstructive renal stones and 16 cases of pyelonephritis. Seven patients lost follow-up. One case each of pyonephrosis and polytrauma had fetal death at term unrelated to urological cause. In rest 75 patients, primary pathology was tackled after 6-8 weeks of delivery.Conclusions: Urological diseases during pregnancy are not an uncommon entity and can pose risk to both mother and fetus. With good clinical vigil, use of minimally invasive procedures, close monitoring and follow up, these patients can be safely managed without any adverse events to the fetus and mother.
ABSTRACT
Background: Inflammation may be one cause of nephrolithiasis and the interleukin-18 (IL-18) encoding gene polymorphisms at +105 A>C has been implicated in several inflammation related diseases. The aim of this study was to test whether IL-18+105 A>C polymorphisms could act as genetic marker for renal stone disease. A case-control study was conducted to observe the genotype distribution of IL-18+105 A>C, to elucidate the possible role of this SNP as risk factor in renal stone development and to examine its correlation with the clinico-pathologic variables. Methods: Using the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) technique, we tested the genotype distribution of 160 nephrolithiasis patients in comparison with 200 disease free controls from the same geographical region. Results: We observed significant differences of IL-18+105 A to C between the controls and patients with odds ratio 5.4 (P = 0.001). The prevalence of the variant genotypes AC + CC in the patients was higher than that in the controls (45% v/s 30%) and showed a significant association (P = 0.003). Moreover, the frequency per copy of the C allele of IL-18+105 A>C was found to be implicated more in patient group 0.27 as against only 0.16 in controls (P = 0.0003). Further, males and subjects with <45 years of age in patient group were significantly associated with variant genotype (P <0.05). Conclusion: Thus, it is evident from our study that IL-18+105 A>C is implicated in renal stone disease, and that the rare, C related allele is connected with higher susceptibility to nephrolithiasis.