Rajanna B, Shivakumar T, Muralidhar B R, Sachin Sachin

A PROSPECTIVE STUDY ON THE MANAGEMENT OF UPPER URETERIC CALCULI AT A TERTIARY CARE CENTRE

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Background: Various options are available for the management of ureteric colic, including conservative management, medical expulsion therapy, and surgical intervention. Primary management of ureteric stones is dependent on various factors, including patient presentation, clinical assessment, and stone characteristics. In the present study, we evaluated and managed all the upper ureteric calculi with respect to feasibility of various procedures, clearance of the stones and their complications. A cross- Methods: sectional study was conducted among 70 patients > 12 years of age with upper ureteric calculi attending Hassan institute of medical sciences, Hassan. All Procedure related complications & side effects during admission & follow-up were documented. 33 (42.9%) patients Results: underwent URSL(Pneumatic) and 33(42.9%) underwent Laser URSL. During guidewire insertion under uoroscopic guidance using cystoscope, the stones were dislodged and migrated in 7 patients and among them 5(6.5%) in ICL (Pneumatic with ureteroscopy) and 2(2.6%) in Laser ureteroscopy procedure. The migrated stone treated with PCNL/RIRS depending upon the size of stones. Stone fragments were migrated in 2 patients who underwent Pneumatic ICL lithotripsy and 1(1.3%) in patients who underwent Laser lithotripsy and it is conrmed byuoroscopy. In 4 (5.2%) of our patient's stones were impacted and large (>20mm) and guidewire could not be negotiated across the stone and hence Ureterolithotomy (Open /Lap) performed and other 2 (2.6%) of our patients did not accept invasive procedures and hence underwent ESWL and 5 (6.5%) were treated medically. In medical treatment, all the patients advised to take Tamsulosin 0.4 mg HS & NSAID'S for 4 weeks and advised to drink water >3.5 litre orally so as to achieve 2.5 litre of urine output. 2(2.6%) patients could not complete the course because of intermittent pain, so they advise URSL, remaining 2 patients completed the course but there was no clearance of the stone, NCCT KUB done and advised for denitive treatment. Stone clearance was higher in LAP/OPEN Conclusion: ureterolithotomy, Laser Lithotripsy. However, the difference in stone clearance rate between various procedures was not signicant. It can be stated that non-invasive procedures are as effective as open surgeries. However, selection of treatment should be based upon the factors such as size, location, Hounseeld units and others which can optimize the outcome for patients who have upper ureteral calculi.

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