CLINICAL PROFILE AND COMPARISON OF OUTCOME OF TREATMENT BY EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND URETERORENOSCOPY IN THE MANAGEMENT OF UPPER URETERIC CALCULI

Authors

  • SHARANJIT SINGH BASRA Surgical specialist, Amritsar, Punjab, India.
  • HIREMATH RN Public Health Specialist, Bengaluru, Karnataka, India.
  • VISHAL VERMA Surgical specialist, New Delhi, India.
  • DOBI SRAVAN KUMAR Medical officer, New Delhi, India.

DOI:

https://doi.org/10.22159/ajpcr.2021.v14i6.41844

Keywords:

Extracorporeal, Shock wave lithotripsy, Ureterorenoscopy, Ureteric calculi

Abstract

Objective: Urinary calculi are the third most common affliction of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. This study was carried out to assess the safety, efficacy, and compare structural and functional outcome after treating the patients of the upper ureteric calculus with Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS).

Methods: A prospective study was conducted on patients with the upper ureteric stone of size 0.5–1.5 cm. A total of 50 patients were included in the study by means of systematic random sampling so as to get 25 patients in each category of ESWL and URS for the treatment of their upper ureteric calculi.

Results: The age ranged from 15 years to 55 years. There were 36 males and 14 females in the study of 50 patients, 43 (86%) presented with pain, followed by 4 (8%) presented with hematuria. Twenty-eight (56%) of the patients had stone in the range of 0.5–1.0 cm, and 22 (44%) of the patients had stone in the range of 1.0–1.5 cm. Sixteen (32%) patients had stone within 2 cm of the pelvi-ureteric junction, and 13 (26%) had stone within 2 cm of the sacroiliac joint. Twenty-one (42%) patients had stone in between these two. Of the 50, 25 patients (50%) underwent shock wave lithotripsy, 25 patients (50%) underwent URS. In the ESWL group, 21 (84%) patients were stone-free after single sitting of ESWL. Four patients (16%) who required Re ESWL, after repeat ESWL two became stone-free however 2 (8%) patient of 1.0–1.5 cm category required secondary procedure, that is, URS and became stone free. To achieve stone-free 1.24 procedure was required per patients. Of the 25 patients in the ESWL group, 2 (8%) patient (one steinstrass case and one poor fragmentation case) required secondary procedure. They underwent URS. Both the patient belonged to 1.0–1.5 cm group. URS was done using semirigid ureteroscope using pneumatic Lithoclast. In our study, two patients of each 0.5–1.0 cm and 1.0–1.5 cm category did not become stone free. These four patients were subjected to ESWL and became stone free.

Conclusion: The management of the ureteral stone should be decided on individual basis, based on stone size, location, symptoms, obstruction, and the availability of the instruments. For stones of 0.5–1.0 cm, ESWL is the treatment of choice for the upper ureteric stones, with very low Re- ESWL (1.12 sittings) without any requirement of ancilliary procedure. URS may be used for the upper ureteric stones but requirement of ancilliary procedure is high 11.11%. For stones between 1.1 cm and 1.5 cm, ESWL is the preferred modality of treatment for the upper ureteric stones.

Downloads

Download data is not yet available.

References

Stoller ML. Urinary stone disease. In: Tanagho EA, McAninch JW, editors. Smith’s General Urology. 17th ed. United States: McGraw Hill Lange; 2008. p. 246.

Ansari MS, Gupta KP. Impact of socio-economic status in etiology and management of urinary stone disease. Urol Int 2003;70:255-61.

American Urological Association. Report on the Management of Ureteral Calculi; 1997. Available from: https://www.auanet.org/a/6327. [Last accessed on 2021 Apr 01].

American Urological Association Education and Research, Inc and European Association of Urology. Guideline for the Management of Ureteral Calculi; 2007. Available from: https://www.auanet.org. [Last accessed on 2021 Apr 01].

Cummings JM, Boullier JA, Izenberg SD, Kitchens DM, Kothandapani RV. Prediction of spontaneous ureteral calculus passage by an artificial neural network. J Urol 2000;164:326-8.

Bierkens AF, Hendrikx AJ, De La Rosette JJ, Stultiens GN, Beerlage HP, Arends AJ, et al. Treatment of mid and lower ureteric calculi: Extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness. Br J Urol 1998;81:31-5.

Francesca F, Grasso M, Da Pozzo L, Bertini R, Nava L, Rigatti P. Ureteral lithiasis: In situ piezoelectric versus in situ spark gap lithotripsy. A randomized study. Arch Esp Urol 1995;48:760-3.

Farsi HM, Mosli HA, Alzimaity M, Bahnassay AA, Ibrahim MA. In situ extracorporeal shock wave lithotripsy for primary ureteric calculi. Urology 1994;43:776-81.

Frabboni R, Santi V, Ronchi M, Gaiani S, Costanza N, Ferrari G, et al. In situ echoguided extracorporeal shock wave lithotripsy of ureteric stones with the Dornier MPL 9000: A multicentric study group. Br J Urol 1994;73:487-93.

Landau EH, Pode D, Lencovsky Z, Katz G, Meretyk S, Shapiro A. Extracorporeal shock wave lithotripsy (ESWL) monotherapy for stones in lower ureter. Urology 1992;40:132-6.

Rassweiler J, Lutz K, Gumpinger R, Eisenberger F. Efficacy of in situ extracorporeal shock wave lithotripsy for upper ureteral calculi. Eur Urol 1986;12:377.

Razvi HA, Denstedt JD, Chun SS, Sales GL. Intracorporeal lithotripsy with the holmium: YAG laser. J Urol 1996;156:912.

Teichman JM, Rao RD, Rogenes VJ, Harris JM. Ureteroscopic management of ureteral calculi: Electrohydraulic versus holmium: YAG lithotripsy. J Urol 1997;158:1357.

Devarajan R, Ashraf M, Beck RO, Lemberger RJ, Taylor MC. Holmium: YAG lasertripsy for ureteric calculi: An experience of 300 procedures. Br J Urol 1998;82:342.

Padhye AS, Yadav PB, Mahajan PM, Bhave AA, Kshirsagar YB,Sovani YB, et al. Shock wave lithotripsy as a primary modality for treating upper ureteric stones: A 10-year experience. Indian J Urol 2008;4:486-48.

Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Ureteral stones clinical guidelines panel summary report on the management of ureteral calculi. J Urol 1997;158:1915-21.

Liong ML, Clayman RV, Gittes RF, Lingeman JE, Huffman JL, Lyon ES. Treatment options for proximal ureteral urolithiasis: Review and recommendations. J Urol 1989;141:504.

Ziaee SA, Halimiasl P, Aminsharifi A, Shafi H, Beigi FM, Basiri A. Management of 10-15-mm proximal ureteral stones: Ureteroscopy or extracorporeal shockwave lithotripsy? Urology 2008;71:28-31.

Olsburgh J, Ramsay J. Lithotripsy for ureteric stones: Throw away the ureteroscope. BJU Int 2003;91:771-2.

Logarakis NF, Jewett MA, Luymes J, Honey RJ. Variation in clinical outcome following shock wave lithotripsy. J Urol 2000;163:721-5.

Muslumanoglu AY, Tefekli AH, Altunrende F, Karadag MA, Baykal M, Akcay M. Efficacy of extracorporeal shock wave lithotripsy for ureteric stones in children. Int Urol Nephrol 2006;38:225-9.

Youssef RF, El-Nahas AR, El-Assmy AM, El-Tabey NA, El-Hefnawy AS, Eraky I, et al. Shock wave lithotripsy versus semirigid ureteroscopy for proximal ureteral calculi (<20 mm): A comparative matched-pair study. Urology 2009;73:1184-7.

Landau EH, Gofrit ON, Shapiro A, Meretyk S, Katz G, Shenfeld OZ, et al. Extracorporeal shock wave lithotripsy is highly effective for ureteral calculi in children. J Urol 2001;165:2316-9.

Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell Walsh, Textbook of Urology. 9th ed. United Kingdom: Saunders; 2007.

Yencilek F, Sarica K, Erturhan S, Yagci F, Erbagci A. Treatment of ureteral calculi with semirigid ureteroscopy: Where should we stop? Urol Int 2010;84:260-4.

Fuganti PE, Pires S, Branco R, Porto J. Predictive factors for intraoperative complications in semirigid URS: Analysis of 1235 ballistic ureterolithotripsies. Urology 2008;72:770-4.

Tiselius HG. Anesthesia-free in situ extracorporeal shock wave lithotripsy of ureteral stones. J Urol. 1991;146:8-12.

Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M. Working party on Lithiasis, European association of urology guidelines on urolithiasis. Eur Urol 2001;40:362-71.

Published

29-07-2021

How to Cite

SINGH BASRA, S., H. RN, V. VERMA, and D. S. KUMAR. “CLINICAL PROFILE AND COMPARISON OF OUTCOME OF TREATMENT BY EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND URETERORENOSCOPY IN THE MANAGEMENT OF UPPER URETERIC CALCULI”. Asian Journal of Pharmaceutical and Clinical Research, vol. 14, no. 6, July 2021, pp. 182-7, doi:10.22159/ajpcr.2021.v14i6.41844.

Issue

Section

Original Article(s)