English

Abstract

INTRODUCTION : Urolithiasis is a very common problem, and the challenges that it has posed has been instrumental in devising various means to tackle the stone burden. With the advent of technology every passing day has seen innovations that has lead to better stone clearance in every individual patient. Since the time H Young1 had attempted his first cystoscopy, efforts were always being made to access the urinary tract efficiently and with lesser morbidity as possible. The inventions like semirigid and flexible ureteroscopes all of which, were an extension of the technology available at the time like rod lens system and fibre-optics systems. With better access, visualization and stone fragmenting techniques, endourological procedures have become a mainstay in treatment of stone diseases. As with advances in vogue at that time, ureteric stents have undergone dynamic evolution in a constant search for the ideal design and material and in a bid to surpass or in the least reduce the symptoms associated with it. Despite the vast evidence supporting non stented ureteroscopies, worldwide many urologists still prefer to place stents in majority of uncomplicated stone removal procedures in a bid to improve drainage ,stone clearance and clear residual fragments and avoid ureteric stricture. Ureteric stents are associated with a wide spectrum of symptoms thereby producing considerable morbidity ranging from 80 to 98% and the discomfort caused varies from patient to patient. The symptoms produced by the stent are predominantly irritative in nature and seems to produce significant bother so as to affect the quality of life of the patient, warranting removal in some cases. AIM OF THE STUDY : 1) To evaluate ureteric stent related morbidity. 2) To evaluate the effect of Tamsulosin in ureteral stent related morbidity. MATERIALS AND METHODS : This is a prospective study conducted from February 2013 to January 2014 at Government Stanley Hospital . A total of 180 patients were enrolled in his study after following the exclusion and inclusion criteria. They are as follows Inclusion Criteria: a) Patients undergoing semirgid ureteroscopy with DJ stenting . b) Only patients with uncomplicated ureteric calculi. Exclusion Criteria: 1. Patients with growth in Urine culture or having symptomatic urinary tract infection. 2. Patients who may need bilateral stent insertion for acute obstruction / obstructive uropathy. 3. Male patients with history of prostatic enlargement, prostatitis or prostatic cancer related lower urinary tract symptoms. 4. Females with lower urinary tract symptoms related to any form of urinary incontinence, uterine/cervical/vaginal prolapse, or obstruction related to malignancy. 5. History of chronic or recent α-blocker or analgesic drug use were excluded. 6. Pregnancy, 7. Bleeding disorders, 8. Patients with concomitant other lower tract pathology like bladder cancer, bladder outlet obstruction with or without stones, urethral stricture. 9. Patients with simultaneous renal calculus. 10. Patients who underwent open surgery for ureteric calculi previously. CONCLUSION : Stenting the ureters following endourologic procedures though being done routinely is not without its problems. It is most commonly associated with considerable symptoms, like irritative voiding symptoms, pain and bother so much, that it affects the quality of life of the patient significantly. The quantum of pain, irritative symptoms and afflicted quality of life which the patient is put through should be borne in mind and carefully weighed against the benefits they might provide and the decision should be individualized in each patient every time. In such cases where stenting is being done ,the patient should be given the benefit of having the stent and at the same time his symptoms should be alleviated by the judicial use of tablet tamsulosin 0.4mg once daily for 14 days. Stent related morbidity is an entity in itself, and the influence of α adrenergic receptor blockers like Tamsulosin over the irritative symptoms is significant due to the distrbution of the α1A and α1D in the lower tract of the urinary system.