Management of Impacted Ureteric Calculus using Ureteroscopy and Pneumatic Lithotripsy - A Prospective Study.

Jayamurugan, B (2007) Management of Impacted Ureteric Calculus using Ureteroscopy and Pneumatic Lithotripsy - A Prospective Study. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Urologists have always been at the forefront of minimally invasive surgery, though for the most of 20th century, these procedures were confined to the lower urinary tract. Over the last two decades, introduction of ureteroscopic and percutaneous techniques has extended our minimally invasiveapproach to upper urinary tracts as well. This technology allows urologists to take their endoscopicexpertise as high as pyelocalyceal system, not just for the stone disease, but for a myriad of benign andmalignant process. Impacted stones in the Ureter are difficult to treat as compared to non impacted stones. Impacted stones are those which tend to stay at the same site over a long period of time. The successrate of ESWL is reported to be quite low in such cases and role of ureteroscopic approach is still beingchallenged for impacted ureteric calculi. In addition, although new lithotripsy instruments such aslaser have been developed, the question of optimal treatment for impacted ureteric calculi remainscontroversial. In the present study, we did a prospective evaluation of the effectiveness of ureteroscopic pneumatic lithotripsy for impacted ureteric calculi. AIMS AND OBJECTIVES : To assess the outcome of ureteroscopy and pneumatic lithotripsy for impacted uretericcalculus. To analyse the factors influencing success of ureteroscopy and pneumatic lithotripsy forimpacted ureteric calculus. To evaluate the immediate complications of ureteroscopy for impacted ureteric calculus. MATERIALS AND METHODS : All patients who came to the our outpatient department between November 2004 and January 2007 with history of loin pain and a diagnosis of ureteric calculus were evaluated for the study and taken upfor ureteroscopy after obtaining informed consent. Patients in whom, the guide wire could not benegotiated beyond the calculus at initial attempts were included in the study. Patients with retrocaval ureter, previous history of ureteric stricture, or obstructive megaureter, ordiabetes and patients with recent evidence of urosepsis were excluded from the study. Patients were analyzed with a devised proforma and the clinical findings and investigation findingswere recorded.Diagnosis of ureteric calculus was confirmed in all patients with USG, x ray KUB and IVP and patientswere sub classified accordingly.Ureteroscopy was done with a Wolf 8-9.8 Fr ureteroscope with a 250W Halogen light source, with asingle chip video camera. Pneumatic lithoclast, with 1 mm probe was used for lithotripsy. For those patients in whom ureteroscopy & lithotripsy was unsuccessful were subsequently managedwith ESWL or Open ureterolithotomy.5 F double J stent was kept as and when necessary, and it was removed at the end of 2 weeks after ensuring complete stone clearance. CONCLUSION : Ureteroscopy with pneumatic lithotripsy is efficacious in the management of impacted uretericcalculus. Size and location of the stone are the factors, which influence the success of ureteroscopy. Ureteroscopy is safe with minimal complications, in the management of impacted ureteric calculus.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Ureteric Calculus ; Ureteroscopy ; Pneumatic Lithotripsy ; Management ; Impact ; Prospective Study.
Subjects: MEDICAL > Urology
Depositing User: Kambaraman B
Date Deposited: 09 Aug 2017 04:08
Last Modified: 09 Aug 2017 04:08

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