Efficacy of Pneumatic Lithoclast in the Management of Urolithiasis in Upper, Middle and Lower Ureter

Iftikhar Ijaz*, Ijaz Ahmed Kharal, Rahat Usman and Junaid Habib Khan

Received: February 15, 2018;   Published: March 01, 2018

DOI: 10.26717/BJSTR.2018.02.000813

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Abstract

BackGround: Pneumatic lithotripter breaks the calculi by oscillatory movement of a solid probe. It is very effective and least morbid approach for all kind of stones in middle and lower Ureter. Although devise is suitable for all parts of Ureter but in upper ureteric calculi, though small, there is a risk of push back in kidneys.

Objective: To determine the safety and efficacy of pneumatic lithoclast for calculi in different parts of the Ureter.

Methods: This was a comparative interventional longitudinal study conducted at depth of Urology K.E.M.U/Mayo hospital, Lahore over a period of 02 years from Jan 2015 till Jan 2017. Those 140 patients who met the inclusion criteria were enrolled for study. Diagnosis of ureteric calculi was confirmed by X- Ray KUB (kidney, Ureter, bladder) Ultrasound KUB and Intravenous Urography. Patients were explained all objectives, merits and demerits of the study and written consent were taken. Based on the location of ureteric stones, patints were divided in 03 groups, which were Group A (upper ureteric stones), B (middle ureteric stones) and C (Lower ureteric stones).

Results: Mean stone size for all 03 groups was comparable (1.09+ 0.24 cm, 1.20 + 0.16 and 1.2+ 0.20 respectively. Upper ureteric stones (Group A) attained complete fragmentation in 44 patints, while extracorporeal shock wave lithotripsy was used for rest of 16 patients. Out of those 44 patients 31 had clearance on day 1, 4 at 2nd week and 9 at 6 weeks. All 37 patients in group B had stone clearance, 17 on day1 and remaining 20 at 2nd week, similarly all 43 in group C had complete clearance, 26 at day 1 and 17 at 2nd week. No complication in pre-op periods were recorded while 40 patients suffered complication in post-op period (Group A=11, group B=13, group C=16).

Conclusion: Pneumatic Lithoclast is safe and effective procedure for ureteric stones. Overall success rate is 88.57% which is comparable to other reported studies. Adaptability of technique is helpful to achieve complete fragmentation and stone Free State.

Keywords: Pneumatic Lithoclast; Ureteric calculi; Ureter

Abstract| Introduction| Patients and Methods| Results| Discussion| Conclusion| References|