Stented versus non stented noncomplicated uretroscopic stone retrieval in noncomplicated bilharzial patients

ABSTRACT

Stented uretroscopic stone retrieval has been a standard procedure for a long time. Few reports appeared in the literature addressing the feasibility of uretroscopic stone retrieval without stenting. Unfortunately, none of these reports addressed the possibility ofnonstented uretroscopy for stone retrieval in bilharzial patients. Our aim was to study the advantage and the disadvantage of nonstented uretroscopic stone retrieval in bilharzial patients without significant bilharzial ureteric complications. One hundred and two consecutive patients were included in this study. Seven patients were excluded from the study due to the occurrence of intraoperative complications necessitating stenting of these ureters. The first 60 patients were assigned to the stented group [5 patients were excluded]. Twenty-eight of these patients were stented by ureteric catheter for 24-48 hrs [group I], while 27 were stented by a Double J stent [group II]. The following 42 patients were assigned to the non stented group [3 patients were excluded] [group III]. All patients were diagnosed as bilharzial [not necessary active] by history of exposure and cystoscopic findings of urinary bladder bilharzial lesions with or without positive bilharzial mtibody litre. Patients with signifcant bilharzial ureteric complications were excluded from the study. Operative time was significantly longer in group II [29.64 +/- 1.33, 37.19 +/- 1.07, 32.23 +/- 1.45 minutes for group I, II, and III respectively]. Early postoperative need for analgesics was highest in group I and lowest in group III. Irritative symptoms were again highest in group I and lowest in group III using International Prostate symptom Score [IPSS]. One week later pain and irritative symptoms were almost completely relieved in group I and III but persisted in group II. Ten patients of this group were still on analgesics at this point. Gross haematuria occurred in 71.4%, 66.7%, and 74.4% of the 3 groups respectively. Hospital stay was statistically less in group II and III compared to group 1 [38.07 +/- 2.59, 15.48 +/- 1.42, 12.36 +/- 0.99 hrs in the 3 groups respectively]. Urinary tract infection was noticeably low in our study affecting 6 patients in the whole study equally distributed between the 3 groups. No postoperative ureteric complications were seen in any of the patients in the three groups as shown by the 1-2 month postoperative IVP. It is evident in this study that non stented ureteroscopic stone retrieval in bilharzial patients is superior to stented procedures regarding post operative symptomatology, operative timing, and hospital stay with no added risk to the patient. These results are consistent with that of ureteroscopic procedures in non-bilharzial patients