MP80-15 CAN FUNCTIONAL STUDIES BE OBVIATED IN MANAGEMENT OF URETERIC CALCULUS? A RANDOMIZED STUDY.

Abstract

You have accessJournal of UrologyStone Disease: Evaluation II1 Apr 2015MP80-15 CAN FUNCTIONAL STUDIES BE OBVIATED IN MANAGEMENT OF URETERIC CALCULUS? A RANDOMIZED STUDY. Raman Tanwar, Nikhil Khattar, Rishi Nayyar, and Rajeev Sood Raman TanwarRaman Tanwar More articles by this author , Nikhil KhattarNikhil Khattar More articles by this author , Rishi NayyarRishi Nayyar More articles by this author , and Rajeev SoodRajeev Sood More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2851AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Based on classic teaching, functional studies (Intravenous pyelography or contrast enhanced CT scan) are often considered a prerequisite before proceeding for surgery for urolithiasis. The routine use of imaging is time consuming and associated with real risks. There is no adequate clinical evidence as to whether detailed functional imaging as a routine has any role in management of calculi and at present no randomized controlled trial exists to evaluate the role and need of such investigations. A randomized study was performed to evaluate the role of functional studies in management of ureteric stones. METHODS 195 patients presenting to the outpatient department with a diagnosis of a demonstrable solitary unilateral ureteric calculus sized 0.5 to 1.5 cm with normal renal function tests and only mild to moderate hydronephrosis were included in the study. Patients with either increased creatinine, gross hydronephrosis with thinned out renal parenchyma, pyonephrosis or pregnancy were excluded. All included patients were randomized using a computer generated table into two groups. In the first group functional imaging was routinely done but in the other group no such study was performed. However, retrograde pyelogram was performed wherever required to delineate the anatomy. All patients were managed initially with medical expulsive therapy for a period of at least two weeks before they were subjected to ureterorenoscopy (URS). All patients were followed up with imaging after 3 months of successful management. The rates of spontaneous expulsion, difficulty or surprises during surgery and incidence of complications were noted. Results and complications in each of these groups were analysed using appropriate statistics. RESULTS 97 patients were randomized to the functional studies arm and 98 patients managed without any functional studies. The mean age, sex ratio, body mass index, size of calculus and location of calculus were comparable. Rate of spontaneous expulsion with medical expulsive therapy was 88.71%. Only 11 cases in each group required URS and 1 patient in each group had perforation. A weakly positive but clinically insignificant correlation was seen between size of calculus and need for URS. No significant difference was found in the spontaneous stone expulsion rates, difficulty and incidence of complications during URS and stone free rates between the two groups. CONCLUSIONS Functional studies may be obviated in management of solitary ureteric calculi amenable to endoscopic treatment in the presence of normal kidney function and absence of gross hydronephrosis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1025 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raman Tanwar More articles by this author Nikhil Khattar More articles by this author Rishi Nayyar More articles by this author Rajeev Sood More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...