Comparative study upper ureteric stone management by ESWL v/s endoscopy v/s open surgery

Dr Nehal Naik; Dr Dhruti Kalsaria; Dr Hiren Parmar

Volume : V, Issue : I, January - 2016

Comparative study upper ureteric stone management by ESWL v/s endoscopy v/s open surgery

Dr Nehal Naik, Dr Dhruti Kalsaria, Dr Hiren Parmar

Abstract :

Background: Within a relatively short time span, the treatment of renal stone has moved from traumatic open surgery through minimally invasive method of percutaneous endoscopic stone removal to totally noninvasive technique of ESWL.The rational approach to management of upper ureteric calculi requires – assessment of efficacy, morbidity and cost associated with various treatment options, which will vary depending upon the location of stone. By using a combination of PCNL and ESWL, 98%of all stones can be treated noninvasively. In only 2% of stones require open surgery. Material and methods: 90 cases of solitary upper ureteric stone were treated with different methods like ESWL, URS, PCNL and open surgery. Patients were selected randomly for any kind of surgical method. All patients were undergone specific investigations like X–ray KUB, USG KUB and intravenous pyelography to diagnose size and location of stones. These different surgical modalities were compared in relation to different factors like– Pain relief after intervention, Stone free state achieved, Hospital stay, Cost effectiveness, Need for 2nd intervention after use of any one treatment modality.(Number of procedures performed), Causes of significant acute complications and Causes of long term complications. Results: For complete removal of upper ureteric calculi, auxiliary measures required in 9 patients and 18 patients were successfully treated with ESWL. 3 patients required second sitting of ESWL. Out of 27 patients, 3 patients developed complications in form of hematuria and colicky pain. No other major complications noted after this procedure. In URS, 22 patients required pneumatic energy for eaking stone, except 2patients who were having soft 8 mm stone. Stone fragments were removed with flexible forceps. Average hospital stay was 1 day at initial visit for DJ stenting and then for 2–3days for URS procedure in follow up visit7 patients were treated as a primary push back PCNL procedure and did not require DJ stenting. In another group of patients, DJ stenting was done at initial visit and after 2–3 weeks upper ureteric stone was manipulated. Open ureterolithotomy was done in large impacted upper ureteric stone with moderate to gross hydronephrosis and/or altered Renal Function Test or as a part of difficult URS or PCNL procedure. Conclusion: From our experience we conclude that: For stone, ≤10mm – ESWL or URS, 11 –15mm –URS or PCNL, 16–20mm – PCNL or Open surgery, ?20mm – Open surgery