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

ABSTRACT

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.