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- Title
Semi-rigid Ureteroscopy and Pneumatic Lithotripsy for upper ureteric stones.
- Authors
Bharali, Mriganka Deuri; Galeti, Ershad Hussain; Shahab, Saqib
- Abstract
Background: The urinary stone disease is the 3rd highest among all urinary problems. These stones may grow and enlarge in the kidney or may enter into the ureter. Objective: This study aimed to know the Outcome of semi-rigid Ureteroscopy with Pneumatic Lithotripsy in Upper Ureteric Stones and to study the stone-free rate, complications, cause of failure of the procedure, rate of retro propulsion into the kidney and rate for conversion to PCNL/ESWL. Materials and methods: This was a prospective observational study of 100 Patients who came with upper ureteric stones to our institute. They were subjected to semi-rigid ureteroscopy and pneumatic lithotripsy over two years after inclusion and exclusion criteria. Ureterolithotripsy was performed with a 6/7.5 Fr semi-rigid ureteroscope (Richard Wolf) and the Swiss lithoclast (Electro Medical Systems, Switzerland) using single or multiple fires to break the stone into small pieces. Results: Division by the stone size, Group 1 with stone size 6-14 mm and group 2 with stone size 15-20 mm. 57 (89%) patients in group 1 were cleared of stone out of 64 patients, while only 24 (66.7%) patients in group 2 were cleared of stone out of 36 patients with statistical significance. Another division is by the location of the stone, Group 1 with stone located at or below the level of the transverse process of the third lumbar vertebra (<L3) and group 2 with stone located above the level of the transverse process of the third lumbar vertebra (>L3). 42 (97.7%) patients with stone located <L3 were cleared of stone out of a total of 43 patients, while 39 (68.4%) patients with stone located >L3 were cleared of stone out of a total of 57 patients with statistically significance. The mean duration of surgery in 81 patients who were cleared of stones was 30.56 + 12.25 minutes. Mean duration (minutes) to clear the stone in group 1 (stone size 6-14mm) was 27.81+11.06 while in group 2(stone size 15-25 mm) was 37.08 + 12.68. The mean duration (minutes) to clear the stone present at or below the level of the transverse process of the third lumbar vertebra (<L3) was 26.43 + 10.89 while >L3 was 35 + 12.19 with statistically significance. Retropropulsion was noted in 9% of the patients. Another causes of failure were narrow ureter (3%), ureteric avulsion (1%), retained stone (4%) and kinked ureter (2%). Patient with ureteric avulsion was subjected to open repair with stone removal and stenting. Conclusion: Semi-rigid ureteroscopy with pneumatic lithotripsy is a safe and effective modality to manage upper ureteric stones. The overall stone clearance rate is good. Stone clearance rate and duration of surgery can be predicted from stone size and location. The complication rate is very low, <5%.
- Subjects
SWITZERLAND; URETEROSCOPY; URINARY calculi; LUMBAR vertebrae; LITHOTRIPSY
- Publication
International Archives of Integrated Medicine, 2021, Vol 8, Issue 6, p40
- ISSN
2394-0026
- Publication type
Article