Extracorporeal Shock Wave Lithotripsy (ESWL) Versus Uretero–Renoscopic Lithotripsy (URSL) For Management Of Upper Ureteric Calculi, Our Experience At Tertiary Care Hospital.

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.

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.

Clinical Study of Transurethral Bladder Micro URSL Joint Puncture and Drainage Treatment for Pediatric Calculus of Lower Urinary Tract / 昆明医科大学学报

Objective To investigate the clinical efficacy of the urethra URSL combined with micro-puncture and drainage treatment for pediatric calculus of lower urinary tract. Methods From January 2003 to January 2013, 66 cases with pediatric urinary tract calculi in our hospital were randomly equally divided into experimental group and control group. The experimental group was treated with transurethral bladder micro URSL combined puncture and drainage treatment, and the control group was given a simple transurethral URSL method of treatment. The operative time, postoperative urine turned clear time,pulling stone clearance after catheter time,postoperative hospital stay and the incidence of postoperative urethral stricture were observed and recorded. In addition, these data were compared between the two groups. Results The operations of two groups have successfully completed. The mean operative time, postoperative urine turned clear time, pull out the catheter stone clearance after time and postoperative hospital stay of control group was 30.2±2.45 minutes,2.5±0.5 days,2.1±0.8 days and 4.0±0. 5 days, respectively. Patients were followed up 1 year after operation, and 1 case of urethral stricture occurred. However, the mean operative time, postoperative urine turned clear time, pull out the catheter stone clearance after time and postoperative hospital stay of the test group was 20.36±2.35 minutes,1.5±0.7 days,1.1±0.25 days and 3.1±0.3 days,respectively,with no urethral stricture case occurred. There were significant differences between the two groups ( <0.05) . Conclusion Transurethral bladder URSL micro puncture and drainage combined with transurethral ureteroscopy lithotripsy treatment for children with lower urinary tract calculi has better efficacy and safety. It could shorter operative time, postoperative urine turned clear time, the gravel discharge time and average hospitalization time, reduce the incidence of postoperative secondary urethral stricture.