Extracorporeal Shock-Wave Lithotripsy in Renal and Ureteric Calculi: Role in Resource Poor Developing Countries in Modern Era

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.

Comparative study of various forms of urinary diversion after radical cystectomy in muscle invasive carcinoma urinary bladder

To compare the three types of urinary diversion namely Ileal Conduit, MAINZ Pouch II and Ileal Neobladder in terms of patient preference, post-operative hospital stay, early and late complications, continence rates, quality of life and patient satisfaction. From January 2003 to October 2007, 30 patients [28 males and 2 females] of muscle invasive carcinoma urinary bladder [mean age 57.7 years] were operated upon by radical cysto- prostatectomy or anterior pelvic exenteration and urinary diversion was performed by Ileal conduit, Mainz pouch II or Ileal neobladder. The patient preference for the type of diversion was determined pre-operatively after discussing all the three types of urinary diversions. Post-operative hospital stay, early and late complications, continence rates, quality of life and patient satisfaction with the type of diversion were evaluated on follow up. 60% of the patient's preferred Ileal neobladder, 10% preferred Ileal conduit and 10% preferred Mainz pouch II as their 1[st] choice diversion; 20% left the decision to the operating surgeon. The mean post-operative hospital stay was 15.0 days in Ileal conduit group, 17.8 days in Mainz pouch II group and 19.7 days in Ileal neobladder group. The mean follow up was 27.7 months. Early complications [within 1 month of surgery] were observed in 46.2% of patients in Ileal conduit group, 38.5% in Mainz pouch II group and 50.0% in Ileal neobladder group. Late complications [after 1 month of surgery] were seen in 61.5% of patients in Ileal conduit group, 46.2% in Mainz pouch II group and 50.0% in Ileal neobladder group. In Mainz pouch II group 92.3% of the patients achieved daytime continence and 84.6% achieved night time continence 3 to 6 months after surgery. In Ileal neobladder group, 75.0% patients achieved day time continence and 50.0% achieved night time continence 3 to 6 months after surgery. Patient satisfaction and overall quality of life was described 'Good' by majority of patients in Ileal conduit group and 'Very Good' by majority of patients in Mainz pouch II group and Ileal neobladder group. There are inherited advantages and disadvantages to each form of urinary diversion and patient selection is important to identify the most appropriate method of diversion for an individual

Intracorporeal Lithotripsy for Ureteral Calculi Using Swiss Lithoclast : SKIMS Experience

At present the techniques available for performing intracorporeal lithotripsy include electrohydraulic, ultrasonic, laser, and ballistic lithotripsy. We present our experience with a unique technology for performing intracorporeal lithotripsy, namely the Swiss lithoclast, which is a form of ballistic lithotripsy. This simple and inexpensive device uses compressed air to activate a solid probe in a manner similar to that of a jackhammer. We report the use of this lithoclast in 92 patients involving a total of 95 ureteral calculi. The lithoclast successfully fragmented 81 of the 95 calculi, a success rate of 85.26%. There were no major complications directly related to the use of this device. The Swiss lithoclast seems to be a safe, effective and an inexpensive means of performing intracorporeal lithotripsy for ureteral calculi.