Study of clinical presentation and emergency retrograde double pigtail ureteric stenting for drainage in calculous anuria.

Muralidharan, K (2007) Study of clinical presentation and emergency retrograde double pigtail ureteric stenting for drainage in calculous anuria. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Calculous anuria constitutes a urological emergency mandatingprompt decompression of the collecting system. Anuria can result due toacute bilateral ureteral obstruction or an unilateral obstruction in asolitary functioning kidney due to urinary lithiasis. In the absence ofrelief of obstruction, this condition may be rapidly complicated byazotemia, uraemia, electrolyte disturbances, acidosis and extracellularfluid volume overload.The optimum method of decompression of renal unit in calculousanuria remains controversial. The early modality for treatment of anobstructed kidney was limited to open nephrostomy. This procedure hadhigh morbidity and mortality. The concept of percutaneous nephrostomywas attractive and the earliest of percutaneous nephrostomy wasdescribed by Goodwin and colleagues in 1955. The emergence of high–resolution ultrasonographic and improved fluoroscopic technique led toreplacement of open nephrostomy by percutaneous procedure.This study deals with the clinical presentation of patients withcalculous anuria; efficacy, feasibility and complications of decompressionof obstructed renal unit in calculous anuria by use of retrograde double-pigtail stent. AIMS &OBJECTIVES : 1. To study the clinical presentation of calculous anuria. 2. To assess feasibility and effectiveness of retrograde double-pigtail stenting in anuria. 3. To study outcome of these cases. 4. To assess complication of double – pigtail stenting in cases ofanuria. MATERIALS AND METHODS : All cases of calculous anuria presenting to our department from November 2004 to February 2007 were included in this prospectivestudy. Patients were studied as per clinical presentation, biochemical andradiological investigations. An attempt of decompression was done withpassage of DJ stent bilaterally or unilaterally in case of solitaryfunctioning kidney. The exclusion criteria were patients with urethralstricture, pregnancy, urinary diversion and clinical diagnosis ofpyonephrosis. CONCLUSION : Calculous anuria is a urological emergency requiring urgentmanagement. Diagnosis of calculous anuria can often be made on the basisof history and clinical examination. Majority of patientshave history and symptoms suggestive of calculous disease.However anuria can be the first presentation of urolithiasis. Ultrasonography and plain radiograph KUB are excellentinvestigations for confirming diagnosis. Retrograde stenting is feasible in calculous anuria. Retrograde stenting can be done in local anaesthesia, avoding the hazards of general or regional anaesthetic in anazotemic patient. Patients of calculous anuria have good outcome, if treatedwith double-pigtail stent with rapid fall of creatinine andnormal renal function is achieved in this patients. Use of double – pigtail stent has a high success rate, lesscomplications and excellent patient compliance.Double pigtail stent has also distinct advantage of earlydischarge. The stent is also helpful in definitive proceduresfor removal of calculi.

Item Type: Thesis (Masters)
Uncontrolled Keywords: emergency retrograde double pigtail ureteric stenting ; drainage ; calculous anuria ; clinical presentation.
Subjects: MEDICAL > Urology
Depositing User: Kambaraman B
Date Deposited: 09 Aug 2017 04:11
Last Modified: 09 Aug 2017 04:11
URI: http://repository-tnmgrmu.ac.in/id/eprint/2528

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