PREDICTIVE FACTORS OF THE OUTCOME OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR UPPER TRACT UROLITHIASIS

Extracorporeal Shock Wave Lithotripsy (ESWL) is one of the treatment options for renal and upper ureteric calculus; however, the outcome depends on multiple factors. Our study aims to evaluate the factors that may inuence ESWL outcomes in Indian patients with upper urinary tract calculi. Between 2018 and 2020, a total of 300 adult patients who underwent ESWL for renal and upper ureteral calculus sizing 5 to 20 mm were included in the study program. Patients with

Management of forgotten double-J stent in a tertiary care center with ten years of experience: a retrospective study

Background: Forgotten double-J (DJ) stents is documented commonly in urological cases with consequences varying from encrustation, UTIs, pyelonephritis, hydronephrosis and non-functioning kidney. This study aimed to present the experience of managing patients with forgotten DJ stents (>3 months) over a period of ten years.Methods: The study conducted a retrospective review of patients with forgotten DJ stents from January 2009 to December 2019. The details reviewed included indications for stent placement, indwelling time, presenting complaints, reason for non removal, radiological investigations, management techniques, and complications.Results: 52 patients with forgotten DJ stents for >3 months were reviewed. Mean age was 32.1 years. The majority were literate (73.1%). Ureteroscopy was the most common primary surgery performed (53.8%). The mean indwelling time was 38.96 months. Presence of the ureteric stone, bladder stone, and renal stone was observed in 45 (86.5%), 42 (80.7%), and 28 (53.8%) patients, respectively. The DJ stent was fragmented in 13.4% of the patients. The commonest complaints were pain (88.4%) and dysuria (63.4%). The stents were managed by combinations of various endourological techniques including cystoscopic stent retrieval (CPE), PCNL, URSL, ESWL with cystoscopic stent retrieval, PCLT (percutaneous cystolithotripsy). Cystolithotomy was used for very large bladder stones. Nephrectomy was needed in 2 cases due to nonfunctional kidneys while one required open ureterolithotomy and stent retrieval after failure of endoscopic approach.Conclusions: Forgotten DJ stents have severe consequences and management approach requires combination of various endourological procedures with ESWL, URSL, PCNL, open ureterolithotomy and cystolithotripsy.

A Study of Comparison between DJ Stenting and Silodosin after Ureteroscopic Lithotripsy for Mid and Lower Ureteric Calculus.

Ureteric calculi are known to affect approximately 10 – 15% of the overall population. We wanted to determine as to whether silodosin can be used instead of DJ stenting in patients with uncomplicated ureteroscopic lithotripsy.METHODSWe selected 60 patients who underwent ureteroscopic lithotripsy (URSL) in the study group. They were divided into ‘stented group’ and ‘non-stented group on silodosin’. Patients with stone of 5 to 18 mm size with no intraoperative mucosal injury and no stricture were included in the study. All patients underwent surgery using an 8/9.8 Fr rigid ureteroscope, without ureteral dilation, with lithotripsy using an electro-hydraulic lithotripter, without extraction. A 4.5 Fr Double J stent was placed in the first group for three to four weeks. The patients underwent urine routine examination, plain x-ray KUB, and ultrasound abdomen before and after lithotripsy. Lower urinary tract symptoms and pain scores were recorded on 3, 7 and 15 days postoperatively. We compared mean operative time, emergency visits, rehospitalisation rates, and residual fragments between each group.RESULTSOut of 60 patients, 53.3% of patients had lower ureteric calculus, 30% had mid ureteric, and 16.7% had calculus at vesicoureteric junction. The mean calculus size on the left side was 10.23 mm, and on the right side was 10.33 mm. The mean intraoperative time was 33.23 minutes in stented and 29.9 minutes in the silodosin group (p< 0.003). Patients underwent assessment for flank pain, fever, and LUTS on postoperative days (POD) 3, 7 and 15. There was no statistically significant difference between the two groups though patients with DJ stent had more symptoms on inquiry. A total of 5 patients in the treatment groups were re-hospitalised, two patients (6.7%) in the stented group, and three patients (10%) in the silodosin group, out of which three patients (5%) required a secondary procedure which was not statistically significant. Three subjects treated with silodosin and 12 with the DJ stent in situ had residual fragments on POD 21 which was statistically significant (p 0.27).CONCLUSIONSPatients with uncomplicated URSL have similar recovery of renal function when treated with silodosin as compared to the placement of DJ stent. Treatment without stent with silodosin also has less irritative LUTS. We conclude that silodosin can be an alternative to DJ stent after uncomplicated ureteroscopic electrohydraulic lithotripsy, thereby reducing operative time and patient morbidity.

Feasibility of minimally invasive management in patients with forgotten double J stent: a single centre experience

Background: aim of the study was to present the experience in managing forgotten/encrusted Double J (DJ) ureteral stents and to review the literature on the subject.Methods: Author retrospectively studied patients presenting to the Outpatient Department from January 2016 to January 2019 with forgotten DJ stent(s) (six or more than six months after the insertion). Data was collected for age, gender, indication for DJ stenting, clinical features at presentation, radiological imaging and surgical procedure performed to extract the DJ stents. The post-operative stay, complications of the procedures and morbidity was also studied.Results: During the study period, a total 32 patients reported to the department with history of forgotten DJ stents. Most common age group involved was 41-60 years. Most common presenting symptoms were lower urinary tract symptoms (LUTS) or dysuria.  Duration of stent in-situ ranged from 6 month to 15 years. Most common sites of encrustations along the forgotten DJ stent were ureter and kidney followed by urinary blabber. Fluoroscopic guided DJ stent removal was done in 8 patients. A combination of Cystolithotripsy, URSL and PCNL was needed to clear the stone and extract the DJ stent in remaining patients.Conclusions: Forgotten/encrusted DJ stent may lead to complications ranging from urinary tract infections to loss of renal function. They can be safely and successfully removed, and the renal function can be preserved. Endo-urological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

A retrospective study on maternal and perinatal outcome in pregnancy requiring DJ stent and PCN during pregnancy

Background: Gestational hydronephrosis (GH) is result of dilatation effect of the progesterone and mechanical compression of the gravid uterus. Management during pregnancy is challenging as routine radiological investigations and surgical treatments cannot be applied due to the potential harm to the fetus. Intervention is indicated in women who fail to respond to conservative management. Acute hydronephrosis and renal colic are common etiologies for loin pain, and can lead to severe form of urinary tract infection affecting perinatal outcome. Ureteric stenting and percutaneous nephrostomy (PCN) during pregnancy are safe, requiring no intra-operative imaging, and inserted under local anaesthesia. It provides good symptom relief, low complication rate, efficient and safe modality for women with refractory symptoms.Methods: A retrospective study of pregnant women admitted under obstetric units with acute hydronephrosis requiring DJ stenting and/or PCN. Aim was to evaluate the course and pregnancy outcomes in a tertiary center of Southern India over a period of five years.Results: Descriptive statistical analysis was done in 12 women with acute hydronephrosis in pregnancy. 66.7% were nulliparous and mean gestational age at admission was 31 weeks. Diagnosis was done by USG. One-fourth had pyelonephritis and calculus being the main pathology (n=9;75%).Women requiring DJ stent and PCN were 41.6% and 58.4% respectively. 41.7% had preterm labour. 66.7% delivered vaginally, birth weight was more than 2.5kg in 50%.Conclusions: Maternal and neonatal outcome mainly depends on the early diagnosis. In this study we emphasize on the importance of multidisciplinary team approach in the management of women with acute hydronephrosis. DJ stent and PCN are efficient and safe modalities in women with refractory symptoms.

A study to evaluate the outcome following Anderson Hynes pyeloplasty in hydronephrosis patients with cummings stent and D-J stent

Background: Uretero-Pelvic Junction Obstruction (UPJO) is an important cause of hydronephrosis in pediatric age group. The choice of treatment could be conservative or surgical. Commonly Anderson-Hynes pyeloplasty is practiced with internal, external or partly internal partly external stent.Methods: This was a prospective study of 40 patients with UPJO, divided into 2 groups consecutively, each consisting of 20 patients. All patients underwent open Anderson-Hynes pyeloplasty. Cummings stent were given in one group for drainage and conventional DJ stent were used for another group.Results: The mean hospital stay was lesser in DJ stent group (8.4±2.13) compared to Cummings stent group (11.4±0.68), not only in respect to primary admission, but also including readmission for cystoscopic stent removal. The incidence of complications was also fewer in Cumming stent group. Stent migration and urinary tract infection (UTI) were more associated with DJ stent (2 each) than Cumming stent (0 each). However, dysuria was more in case of cumming stent (2 patients) than DJ stent (1 patient).Conclusions: The mean hospital stay in DJ stent insertion is less even if duration for cystoscopic removal is considered. The complication of stent removal and UTI are more with DJ stent though dysuria is more in case of Cummings stent.

An Unusual Case of Retained DJ Stent

Double J stents are an integral part of urological practice today. Ureteral stenting is done as an adjunct to ureteral surgery and for managing ureteral obstruction. Every urological surgery doesn't require DJ stenting and their use must be strictly restricted to selected cases. Retension is a common complication of ureteral stents and is mostly due to encrustations on a forgotten DJ stent. Here we report a case of retained DJ stent which was placed during open nephrolithotomy. It was neither forgotten nor encrusted, but was embedded in the renal parenchyma. As per our knowledge this is the first case of its kind to be reported in medical literature.

Does every Ureteroscopic Lithotripsy (URSL) patient need to suffer stent symptoms?

Background: Double J stent is a tube placed in the lumen of the ureter to maintain its patency. Double J coils at proximal and distal ends makes it self-retaining by securely anchoring it at renal pelvis and at bladder levels. Materials and methods: A total of 661 patients operated for ureteric calculus from June 2014 to September 2017 at Jeevan Hospital, Omni Hospital, Healthcare Hospital and Evya Hospital Hyderabad, Telangana were studied. Jeevan Hospital was selected to follow strict indications for DJ stenting after ureteroscopic stone removal. Other hospitals were selected for routine DJ stenting after ureteroscopic stone removal. 378 cases were operated in Jeevan hospital and only 54 cases required DJ stenting. Results: Over all the rate of ureteral stenosis was seen in 4 patients (0.60%) of which 2 were from stented group and 2 (0.30%) were from non-stented group and 2 (0.30%) patients required ureteroneocystostomy, 1 patient required ureteroneocystostomy with psoas hitch and one patient was on DJ stent and was on follow up. Conclusion: Stent could be safely avoided in 85.7% of cases following strict indications for stenting. Complications like ureteral stricture are not limited to non-stented group. Judicious use of stent makes many patients symptom free, and makes them to resume duties early and sexual activity early.