Percutaneous calyceal irrigation calculi during percutaneoius nephrolithotomy

Objectives: Percutaneous nephrolithotomy performed for the management of complex renal calculi is a challenging endourological procedure. In complex situations multiple tracks and Y tracks may be needed to achieve complete stone clearance. These maneuvers carry a risk of complications especially bleeding. This study was carried out to evaluate the efficacy of the use of percutaneous calyceal irrigation (PCI) for small calyceal calculi during percutaneous nephrolithotomy. Patients and Methods: Fifty patients; in whom percutaneous calyceal irrigation (PCI) was attempted; were retrospectively evaluated. Results: Complete stone clearance was achieved with the help of PCI in 62renal units. There were no complications attributable to PCI. Conclusion: Our results encourage the use of PCI as a simple technique for clearance of small calyceal calculi thus preventing the need for a second track or Y track

Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy.

OBJECTIVE: To compare the success, efficacy and complications of ureteroscopy (URS) and extra corporeal shock wave lithotripsy (ESWL) for the treatment of symptomatic small non obstructing lower ureteric calculi. SUBJECTS AND METHODS: This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm) lower ureteric calculi (situated below the sacroiliac joint), with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures. RESULTS: Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10%) where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy. CONCLUSION: ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.