Experience of ureteric obstruction following ESWL and its management

ABSTRACT

One hundred consecutive patients with radiopaque renal stones size ranging between 5 to 35 mm were included. Prior to ESWL treatment double J ureteral stent was inserted in all patients [n=23] who had stone size over 20 mm to prevent risk of ureteric obstruction. Renal ultrasound and x ray KUB were required in every patient at each follow up to assess pulverization, steinstrasse and hydronephrosis. Overall ureteric obstruction due to steinstrasse was noted in 16 patients [16.0%]. The incidence of steinstrasse was 15/77[19.4%] when stone size was 5 to 20mm while it was 1/23 [4.3%] when stone size was above 20mm with double J ureteral stent in place. Adequate pulverization for clearance was 0% at the end of 4 months in the patients with stone size over 20mm. In 3 unstented patients ureteric obstruction was complicated with fever, nausea, vomiting and moderate to severe colic and hydronephrosis and uncomplicated in remaining 13 patients [1 stented and 12 unstented]. Double J ureteral stent was costly and associated with complications like frequency [34.8%], urgency [30.4%], lumber pain [39.1%], bladder pain [34.8%] fever [34.8%], burning micturition [8.7%], difficulty in walking [8.7%]. For complicated ureteric obstruction following ESWL in 5-20 mm size stones PCN and repeat ESWL is recommended in preference to double J stent wich is associated with a high morbidity. ESWL should not be offered to patients with stone size more than 20 mm.