Abstract
Background: Uro-lithiasis is one of the most frequent urological disorders seen on a daily basis. Ureterorenoscopic Lithotripsy has traditionally been used to treat distal ureteric calculus (URSL). Extra-corporeal Shock-wave Lithotripsy (ESWL) using a trans-gluteal route has recently been investigated. Aims & objectives: The goal of this study is to see how supine trans-gluteal ESWL works on distal ureteric calculus and compare it to semi-rigid ureterorenoscopy in the management of distal ureteric calculus. Material & methods: A total of 240 subjects were included in our trial, which lasted a year and was randomly separated into two categories by an independent observer. After collecting consents, taking a full history and doing clinical examinations as needed, and conducting the necessary biochemical and radiological studies, Category A was offered ESWL while Category B was offered URSL. After 15 days after the procedure, the subjects were followed up on. Results: Many subjects, especially the elderly, obese, and those with physical disabilities or poor mobility, prefer the supine posture SWL. When the patient and calculus characteristics were compared, there was no discernible difference between the two categories. In both categories, males make up the bulk of the subjects (82 percent). The supine trans-gluteal SWL category had an 89 percent calculus-free rate. Conclusion: We conclude that ESWL management has a low morbidity and high effectiveness, and that the results are comparable to those of uretero-scopy with intra-corporeal lithotripsy, with the added benefits of an outpatient operation, no need for anaesthesia, and the use of DJ stents. Keywords: Distal Ureteric Calculus, URSL, Trans-gluteal ESWL, Calculus clearance.
Highlights
The most common symptom of ureteric calculus is acute colicky pain, and the goal of management is to remove the calculus completely with little morbidity for the patient
The fragility of a calculus is determined by the density of calculus evaluated by NCCT, calculus Hounsfield Unit (HU), which changes with calculus composition and affects the clinical result in ESWL2
The patient is in a supine position, and the shock-wave is administered to the distal ureter through the gluteus maximus
Summary
The most common symptom of ureteric calculus is acute colicky pain, and the goal of management is to remove the calculus completely with little morbidity for the patient. Extra-corporeal shock wave lithotripsy (ESWL) is the least intrusive management for upper urinary tract calculi and is suggested as the first line of management. The supine position, with the shock-wave head in contact with the patient's loin, was designed for the renal and upper ureteric calculus[3]. The prone position was modified for mid or distal ureteric calculus, with the shock-wave head in touch with the patient's anterior belly. There is yet to be discovered a safe and successful method of treating calculus in the distal ureter with results inferior to supine ESWL for renal and upper ureteric calculus[4,5]. The patient is in a supine position, and the shock-wave is administered to the distal ureter through the gluteus maximus
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