Abstract
Objective: To assess safety and feasibility of completely non-fluoroscopic ureteroscopy for treatment of mid and distal ureteric stone in term of stone free-rate and complications.Material and Methods: Over study period between January 2014 and January 2015, ninety-one complete fluoroscopy-less semirigid ureteroscopies were performed for treatment of symptomatic ureteric stones. Age, sex, stone size, location, side, operative time, auxiliary procedures, stonefree rate and complications, all were assessed. A Stone-free rate was defined as the lack of radiographic evidence of residual stone at 4 weeks. Postoperative imaging, and complications were grading according to modified Clavien classification system, which used initially to grade complications of general surgery.Results: The average age of our subjects was 32.9, with male and right side predominant, 68 % and 64.8% respectively. The average stone size and operative time were 10.07 and 32.08 respectively. Fifty six semirigid retrograde ureteroscopies were done for distal ureteric and 35 for mid ureteric stones, achieving 91.2% stone free rate, with overall intraoperative complications of 18.6%. All cases were managed on day case basis, ureters were stenting preoperatively in 37 patients and all cases were stenting with an appropriate size of double J.Conclusion: Zero fluoroscopic semirigid retrograde ureteroscopy is a safe and feasible treatment modality for management of distal and mid ureteric stones.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.48-52
Highlights
Urolithiasis is a major clinical and economic burden for modern health care system, at an annual cost of more than two billion dollars.[1]
The treatment for urinary calculi has continuously evolved in last decades from cut for stone to fish out the stone, with the number of ureteroscopies (URS) performed for stone disease increasing by 127% over last 10 period 2000-2010, as consequences of technological advances in medicine, in endourology; in addition the current guidelines recommended URS, over other treatments modalities including open surgery and in situ extra corporeal shock wave lithotripsy (ESWL), for majority of ureteric stones, with low complication rates, high stone free rate, short hospital stay and minimal contra-indications for the procedure.[3,4]
Conventional ureteroscopy relies on intraoperative fluoroscopy for guidance and visualization, exposing operating room staff, surgeon and patient to non-ionizing radiation, exposure from single, fluoroscopically ureteroscopy is relatively low compared with levels delivered by a computed tomography (CT) scan, the effects are cumulative and many patients with stone disease require more endourological procedures and CT scan.[5]
Summary
Urolithiasis is a major clinical and economic burden for modern health care system, at an annual cost of more than two billion dollars.[1]. The treatment for urinary calculi has continuously evolved in last decades from cut for stone to fish out the stone , with the number of ureteroscopies (URS) performed for stone disease increasing by 127% over last 10 period 2000-2010, as consequences of technological advances in medicine, in endourology; in addition the current guidelines recommended URS, over other treatments modalities including open surgery and in situ extra corporeal shock wave lithotripsy (ESWL), for majority of ureteric stones, with low complication rates, high stone free rate , short hospital stay and minimal contra-indications for the procedure.[3,4].
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