Extracorporeal Shock Wave Lithotripsy (ESWL) versus Uretero–Renoscopic Lithotripsy (URSL) for management of upper ureteric calculi, our experience at tertiary care hospital.

Haamid Hassan Bhat; Abid Akbar Sofi; Shahnawaz Mansoor; Prof. Baldev Singh Wazir

Volume : VII, Issue : III, March - 2018

Extracorporeal Shock Wave Lithotripsy (ESWL) versus Uretero–Renoscopic Lithotripsy (URSL) for management of upper ureteric calculi, our experience at tertiary care hospital.

Haamid Hassan Bhat, Abid Akbar Sofi, Shahnawaz Mansoor, Prof. Baldev Singh Wazir

Abstract :

Background: Urinary stones are the third most common affliction of urinary tract, exceeded only by urinary tract infections and pathological conditions of prostate (BPH and Prostate cancer). Extracorporeal Shock Wave Lithotripsy (ESWL) and Uretero–renoscopic Lithotripsy (URSL) are among various treatment options available.

Aims and Objectives: To compare ESWL and URSL procedural and post procedural characteristics including outcome.

Methods: A Prospective study was conducted in the department of Urology, SKIMS, on 100 patients with proximal Ureteric stone, from September 2015 to July 2017.By random selection, fifty patients were subjected to ESWL and another fifty to URSL. Various parameters were recorded on preformed proforma designed for the comparative study.

Results: In our study, Parameters like Age and Gender distribution, symptoms at presentation and duration of symptoms, number of stones, laterality of stones (right/left) and grade of Hydronephrosis or Hydroureteronephrosis were uniformly distributed in the two groups (URSL VS ESWL). Spinal anaesthesia (SA) or General Anaesthesia(GA) was required in URSL group only, while as local anaesthesia and sedation was required in some patients in ESWL group. 72% and 88% patients achieved stone clearance in ESWL and URSL group respectively, (p=0.046). DJ stent was used in 20% of URSL patients and none in ESWL group. Procedure time was relatively less for URSL (p=0.001). Although statistically insignificant, Post procedure hematuria and urosepsis were higher in URSL group, where as pain/colic and fever was slightly higher in ESWL group. Steinstrasse was significantly higher in ESWL group (p=0.008). Hospital stay was significantly higher in URSL group (p<0.001). Cost involvement was higher in ESWL group (p=0.016).

Conclusion: Although ESWL is regarded as the preferred choice of treatment for upper Ureteric stone, URSL is a safe alternative, with an advantage of obtaining an earlier or immediate stone free status in patients with stone size >10mm. In patients with smaller stones (<10mm), ESWL may be considered a reasonable alternative to URSL.