EARLY EXPERIENCE OF PNEUMATIC LITHOCLAST FOR THE MANAGEMENT OF URETERIC STONES AT PESHAWAR
AbstractBackground: Pakistan lies in the Afro-Asia stone belt. Ureteric calculi are common occurrence and a major burden on health care facilities in Pakistan. The objective of this study was to assess the efficacy and safety of pneumatic lithoclast in the management of ureteric calculi. Methods: Case series study Department of Urology at Institute of Kidney Diseases Hayatabad Peshawar, from 1st Oct 2010 to 1st Oct 2011. One-hundred adult patients with ureteric calculi ≥ 0.7 cm were evaluated by history, physical examination, routine blood and urine examination after taking their written informed consent and approval of ethical committee. Ultrasound and X-ray KUB were done with IVU if required. All patients underwent ureteroscopy within intracorporeal lithotripsy and JJ stenting. Patients were followed up with post-op X-ray KUB at 24 hours and then weekly intervals till they became stone free. Following parameters were assessed: stone size, site, laterality, degree of fragmentation, success rate, stone migration and complications. Inability to reach the calculus with URS, proximal migration of stone or requirement of another/auxiliary procedure was considered failure. Results: One hundred and ten patients were enrolled with a mean age of 38±10 years. There were 72 males and 28 females. Fifty-eight calculi were on right and 42 on left side. 24, 24 and 52 stones were in upper, middle and lower ureter respectively. Forty stones measured 7–10 mm, 52 measured 11–15 mm and 8 measured 16–20 mm in size. 98 stones were broken while 2 calculi migrated proximally. Overall success rate was 90% (Efficiency Quotient =78.95). Success rate in upper, middle and lower ureter was 83.3%, 83.3% and 96.1% respectively. 10 and 2 patients required ESWL and open ureterolithotomy, respectively, as additional treatment. Mean operative time was 33.5 minutes. There were no major complications. Conclusions: Pneumatic lithoclast with URS is effective and safe in the management of the ureteric calculi with some limitations in the upper ureter.Keywords: Ureteric stones; Ureterorenoscopy; Pneumatic Lithoclast
Tipu SA, Malik HA, Mohhayuddin N, Sultan G, Hussain M, Hashmi A, et al. Treatment of ureteric calculi-use of Holmium: Yag Laser lithotripsy versus pneumatic lithclast. J Pak Med Assoc 2007;57(9):440–3.
Krambeck AE, Murat FJ, Gettman MT, Chow GK, Patterson DE, Segura JW. The evolution of ureteroscopy: A Modern Single-Institution Series. Mayo Clin Proc 2006;81(4):468–73.
Ghalayini IF, Al-Ghazo MA, Khader YS. Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: Efficacy and patient satisfaction. Int Braz J Urol 2006;32(6):656–67.
Nikoobakht MR, Emamzadeh A, Abedi AR, Moradi K, Mehrsai A. Transureteral lithotripsy versus extracorporeal shockwave lithotripsy in management of upper ureteral calculi: a comparative study. Urol J 2007;4(4):207–11.
Rana AM. Comparison of results of Ureteroscopy for proximal and distal ureteral calculi using rigid ureteroscope. Med Channel 2005;11(2):58–60.
Shaikh AH, Khalid SE, Zaidi SZ. Ureteroscopy under spinal versus general anaesthesia: Morbidity and stone clearance. J Coll Physicians Surg Pak 2008;18(3):168–71.
Shaikh AR, Shaikh QA, Shaikh AF, Soomro MI, Shaikh NA, Jokho AH. Ureterolithtripsy with semi-rigid ureteroscope: an early experience with 100 cases. J Surg Pak 2007;12(3):98–101.
Geavlete P, Georgescu D, Nita G, Mirciulescu V, Cauni V. Complications of 2735 retrograde semirigidureteroscopy procedures: a single-center experience. J Endourol 2006;20(3):179–85.
White W, Klein F. Five years clinical experience with the Dornier delta lithotripter. Urology 2006;68(1):28–32.
Mugiya S, Nagata M, Un-No T, Takayama T, Suzuki K, Fujita K. Endoscopic management of impacted ureteral stones using a small caliber ureteroscope and a laser lithotripter. J Urol 2000;164(2):329–31.
Olsburgh J, Ramsay J. Lithotripsy for ureteric stonethrow away the ureteroscope. BJU Int 2003;91(9):771–2.
Bromwich EJ, Lockyer R, Keoghane SR. Day-case rigid and flexible ureteroscopy. Ann R Coll Surg Engl 2007;89(5):526–8.
Akhtar MS, Akhtar FK. Utility of the lithoclast in thetreatment of upper, middle andlower ureteric calculi. Surgeon 2003;1(3):144–8.
Zehri AA, Ather MH, Siddiqui KM, Sulaiman MN. A Randomized Clinical Trial of Lidocaine Jelly for Prevention of Inadvertent Retrograde Stone Migration during Pneumatic Lithotripsy of Ureteral Stone. J Urol 2008;180(3):966–8.
Wazir BG, Orakzai AN, Shamsher S, Ul Haq MI. Symptomatic complications of ureteric stents. J Postgrad Med Inst 2011;25(3):263–6.
Jeong H, Kawak C, Lee SE. Ureteric stenting forureteric stones; a prospective randomized study assessing symptoms and complications. BJU Int 2004;93(7):1032–4.
HongYK, Park DS. Ureteroscopic Lithotripsy Using Swiss Lithoclast for Treatment of Ureteral Calculi: 12-Years’ experience. J Korean Med Sci 2009;24(4):690–4.
Brito AH, Mitre AI, Srougi M. Ureteroscopic Pneumatic Lithotripsy of Impacted Ureteral Calculi. Int Braz J Urol 2006;32(3):295–9.