A STUDY TO COMPARE THE OUTCOME OF SELECTED SURGICAL PROCEDURES FOR PROXIMAL URETERAL STONE TREATMENT AT CARE INSTITUTE OF MEDICAL SCIENCES, HYDERABAD FROM MAY 2011 TO APRIL 2013
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 56
Abstract
BACKGROUND Urinary stone disease causes morbidity, thus lead to loss of wages and economy. The estimated prevalence is 2% - 3% with lifetime risk of 12% for white males and 5% - 6% for white females, and lifetime recurrence rate is 50%. The increased incidence of urinary stones in the industrialised world is associated with improved standards of living (mainly including the high dietary intake of proteins and minerals). Treatment outcome mainly depends upon clinical, anatomic, stone factors and especially on available equipment, expertise and cost. Stone diameter ≥ 4 mm is associated with a progressive decrease in the spontaneous passage rate, which is unlikely with stones ≥ 10 mm in diameter. Proximal ureteral stones are also less likely to pass spontaneously, so they are often removed by surgical procedures. Objectives- 1). To assess the prevalence and risk factors of Upper urinary tract calculi among Genitourinary surgical department patients, Care Institute of Medical Sciences, Hyderabad from May 2011 to April 2013; 2). To compare the outcome of the selected treatment procedures in the same study population and study setting and study period. MATERIALS AND METHODS This prospective cohort study conducted from August 2011 to July 2013 among 90 eligible proximal ureteral stone sufferers by grouping them into Group 1 (PCNL- Percutaneous nephrolithotomy), Group 2 (URSL- Ureteroscopic lithotripsy) and Group 3 (ESWL- Extracorporeal shock wave lithotripsy) as per their type of treatment. After collection of the personal, social, economic and clinical and lab tests information, we gave the selected treatment and followed them up to 3 months. During followup if stone fragments are retained, then we performed additional procedures and treated the complications if any. Lastly, outcome comparison between 3 treatment groups was done. RESULTS Study has shown 35% prevalence of the renal calculi, out of which about 75.71% of them were of proximal ureteral calculi sufferers who have shown bimodal age distribution at ≥ 30 and ≥ 50 years. Overall, stone free rate after the initial and additional treatment procedures was 100% in PCNL group, but 96.67% and 93.33% in URSL and ESWL groups irrespective of the stone size. Mean cost treatment was high with PCNL procedure than others. Mean length of hospital stay was high in URSL followed by ESWL and PCNL. The retained ureteral stone fragments were high among ESWL group with 33.33%, whereas highest numbers of complications were seen in URSL group followed by ESWL and PCNL groups. CONCLUSION Based on above observations, we concluded the study by saying that PCNL is cost effective method for proximal ureteral calculi treatment than other two
Authors and Affiliations
Ch. Koteswaramma Ch. Koteswaramma, Mussar Mussar
Keywords
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- EP ID EP226129
- DOI 10.14260/Jemds/2017/905
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