Comparative study of different modalities of treatment for large upper ureteric calculi

Authors

  • Prashant Purushotham Darakh Department of Urology, JSS Medical College, Mysuru, Karnataka, India
  • Ravikumar Banavase Ramesh Department of Urology, JSS Medical College, Mysuru, Karnataka, India
  • Chirag Doshi Department of Urology, JSS Medical College, Mysuru, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20191482

Keywords:

Urolithiasis, ESWL, RIRS, Laparoscopic ureterolithotomy

Abstract

Background: Urolithiasis is one of the most common urological diseases and has become a worldwide health problem. Minimally invasive therapies such as extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, RIRS and laparoscopic surgery have revolutionized the treatment of ureteric calculi, altering surgical treatment dramatically.

Methods: It was a prospective randomized study conducted between March 2012 to March 2017. 60 patients with large upper ureteric calculi of >15 mm in size were randomly selected for the study. Diagnosis was made using ultrasonography, plain X-ray KUB, IVU and spiral CT KUB. Patients were divided randomly into 4 groups of 15 patients each. Routine post-op X-ray KUB and USG were done for all the patients. All the data was recorded and analysed.

Results: LAP group had the highest stone clearance rate (100%) in our study. The difference in stone clearance rate was statistically significant when compared with ESWL (73.33%) and URS group (66.7%), whereas no statistical significance was found between LAP and PCNL group (93.33%). URS group in our study had highest intra-operative complications (33.33%) and laparoscopic group had least number of complications. Post-procedural complications occurred in 1 patient (6.7%) in URS group, 2 patients in ESWL group (13.3%) and 1patient each in LAP and PCNL group (6.7%).

Conclusions: Laparoscopic ureterolithotomy is a feasible and effective method of treating large (>15 mm) upper ureteric calculus. It is associated with least intra-operative complications and semirigid ureteroscopy has highest intra-operative complications.

 

References

Pak CY, Resnick MI, Preminger GM. Ethnic and Geographic Diversity of stone disease. Urology 1997;50:504-7.

Schade GR, Faerber GJ. Urinary Tract Stones. The clinics.com. 2010: 565-581.

Ramello A, Vitale C, Marangella M. Epidemiology of nephrolithiasis. J Nephrol. 2000;13:65-70.

Clark JY, Thompson IM, Optenberg SA. Economic impact of urolithiasis in the United States. J Urol. 1995;154:2020-4.

Sodickson A, Baeyens PF, Andriole KP. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiol. 2009;25:175–84.

Francesca F, Scattoni V, Nava L, Pompa P, Grasso M, Rigatti P. Failures and complications of transurethral ureteroscopy in 297 cases:conventional rigid instruments vs. small caliber semirigid ureteroscopes. Eur Urol. 1995;28:112.

Yaycioglu O, Guvel S, Kilinc F, Egilmez T, Ozakardes H. Results with 7.5F versus 10F rigid ureteroscopes in treatment of ureteral calculi. Urology. 2004;64:643.

Dretler SP, Keating MA, Riley J. An algorithmfor the management of ureteral calculi. J Urol. 1986;136:1190-3.

Mueller SC, Wilbert D, Thueroff JW, Alken P. Extracorporeal shock wave lithotripsy of ureteral stones:clinical experience and experimental findings. J Urol. 1986;135:831-4.

Chaussy CG, Fuchs GJ. Current state and future developments of noninvasive treatment of human urinary stones with extracorporeal shock wave lithotripsy. J Urol. 1989;141:782-9.

AUA/EAU clinical guidelines. Available at: http:// www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/uretcal07/ chapter1.pdf. Accessed on 3 June 2018.

ElGanainy E, Diaa AH, Elgammal MA, Abd-Elsayed AA, Shalaby M. Experience with impacted upper ureteral Stones; should we abandon using semirigid ureteroscopes and pneumatic lithoclast? Int Arch Med. 2009;2:13.

Halachmi S, Nagar M, Golan S, Ginesin Y, Meretyk S. Extracorporeal shock wave lithotripsy for large ureteral stones using HM3 lithotriptor. J Urol. 2006;176(4):1449-52.

Goel R, Aron M, Kesarwani PK, Dogra PN, Hemal AK, Gupta NP. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol. 2005;19(1):54-7.

Whitfield HN. The management of ureteric stones, Part 2: Therapy. BJU Int. 1999;84:916-21.

Marchant F, Storme O, Osorio F, Benavides J, Palma C, Ossandón E. Prospective trial comparing shock wavw lithotripsy and ureteroscopy for the management of distal ureteral calculi. Actas urol Esp. 2009;33(8):869-72.

Shi-Wei H, Chien- H, Chung-JW. Percutaneous nephrolithotomy for the treatment of staghorn calculus. JTUA. 2005;16(4):169-73.

Downloads

Published

2019-04-29

Issue

Section

Original Research Articles