Anand, A (2013) Comparative study of extracorporeal shockwave lithotripsy outcomes for renal stones with and without stenting. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Urolithiasis has afflicted mankind since antiquity. Stone disease of the urinary tract is common, and many forms of treatment has been in vogue. Until early eithties open surgery and other endoscopic techniques were the treatment modalities available for Urolithiasis. Extracorporeal shock waves lithotripsy (ESWL) was introduced by Christian Chaussay in 1980. Since mi 1980’s ESWL has been established as a minimally invasive procedure for a wide indications of urinary stones. This revolutionized the management of the stone disease throughout the world. ESWL is usually an outpatient procedure. ESWL is a safe, effective method to treat urinary lithiasis. The success rate in ESWL depends on stone location, size, number, and fragility as well as calyceal anatomy and patency of the urinary tract. AIMS AND OBJECTIVE: To compare the outcomes of ESWL with and without stenting for Renal stones measuring 10mm to 20mm. MATERIALS AND METHODS: This is Prospective study of 150 patients with renal stones treated with ESWL at Kilpauk Medical College Hospital, Chennai and Government Royapettah Hospital, Chennai during January 2011 to December 2012. Inclusion Criteria: All patients with Renal stones measuring 1-2 cms in size are included in the study. Exclusion Criteria: stones < 1 cm or >2 cms. • Renal anomaly – Horse shoe kidney, Malrotated kidney. • Calyceal diverticulum. • Distal obstruction. • Uncontrolled infection. • Coagulation disorder. • Pregnancy. • Previous renal surgery. In all the patients history and physical examination were done. Baseline investigations inckuded Complete Haemogram, RFT, urine C/S, X-ray KUB, USG KUB, IVU and CT KUB, Stone location, stone lsize, favourable/un favourable lower pole calyceal anatomy and Hounsefield unit of the stone were recorded. Patients were explained about the study, ESWL procedure and informed consent were obtained. Patients were randomly allotted to stented and Insitu group. Stenting was done under regional anaesthesia using a regid cystoscope, in difficult cases stenting was done using regid Ureteroscope. ESWL was done in outpatient procedure at Rajiv Gandhi Government General Hospital, Chennai. ESWL was done using Dornier Compact Delta II (Electromagnetic Generator) Machine. Patients were administered sedation IV Fortwin (20mg), 30 minutes before procedure. Patients were followed up after 2 weeks and at 4 weeks, X-ray KUB and USG KUB were done to look for residual fragment. Presence of residual fragments (>4mm) after 2 sittings of ESWL is taken as treatment failure. RESULTS: 150 patients were included in this study. They were randomized into two groups of 75 patients each. Group A was stented before ESWL. Group B was treated with ESWL without stenting. Most of the stented patients did experience mild stent related complications which did not require any hospitalization. Incidence of steinstrasse was statistically significant in both groups in our study population which could be due to the small stone size of 10mm-20mm were only included in this study, this was similar to the observations reported by suliman et al. with regard to stone location only 50% success rate could be achieved for lower pole calculus measuring 10mm-20mm, whereas success rate with other location was good, which is statistically significant. With regard to stone size there was no statistically significant difference with success rate, complications and residual fragments. CONCLUSION: 1. There is no statistically significant difference between in stone clearance rate between ESWL with stenting and without stenting for renal stones measuring less than 20mm. 2. There is no statistically significant difference between stenting and without stenting with regard to steinstrasse for renal stones measuring less than 20mm. 3. Lower pole location significantly reduced the success rate of ESWL for stones measuring between 10mm-20mm. 4. renal stones with Hounsfield unit of more than 1000 HU had significantly reduced success rate of ESWL and increased number of ESWL sittings. 5. Stones with Hounsfield unit of more than 1000 HU had significantly increased incidence of steinstrasse and complications following ESWL. 6. Stneting before ESWL in uncomplicated cases of renal stones measuring less than 20mm increases the stent related complications and overall treatment cost. 7. Stenting before ESWL is not beneficial in uncomplicated cases of renal stones measuring less than 20mm.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | extracorporeal shockwave lithotripsy ; outcomes ; renal stones with and without stenting ; Comparative study. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:11 |
| Last Modified: | 12 Oct 2017 01:11 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3452 |
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