DIURESIS AND MEDICAL EXPULSION THERAPY WITH EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR CLEARANCE OF RENAL STONE- A CLINICAL STUDY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 54
Abstract
BACKGROUND Renal stone has a global problem. People of all country of the world more or less suffer from Renal Stone or Urinary Calculus. It is prevalent in about all age and sex groups. It carries significant morbidity, mortality and imposes heavy financial load. It causes tremendous financial burden on health and medical care delivery system with changing lifestyle, environment and climate. Its prevalence is rising. It requires stress on preventive and curative aspect. Various procedures like Conventional Operation, Endoscopic Method, PCNL, URS and Extracorporeal Shock Wave Lithotripsy are used in practice. The ESWL was invented in 1980. It has various type of generation machines. It is operated by Technician, Surgeon and Urologist. It is not invasive and has low-risk procedure, but has incidence of residual fragments, microparticles, dust and crystals despite many advancements in Technology. So, Diuresis with oral and parenteral water and fluid and Medical Expulsion Therapy and excretion through passage of urine causes clearance in same procedure sessions with no extra cost. In outdoor patients of less than 2 mm diameter stone, Medical Expulsion Therapy was given. In indoor hospitalised patients of more than 2 to 20 mm diameter, MET, ESWL with diuresis were performed. MATERIALS AND METHODS Study was performed between January 2015 and September 2015 in Lord Buddha Koshi Medical College and Hospital and Sri Krishna Salya Chikitsalaya, Saharsa (Bihar), after consent from Institutional Review Board and from patient for Examination, Investigation, Diagnosis, Treatment and Research and Study; 60 patients of various age and sex groups were undertaken. ESWL with Diuresis and Medical Expulsion Therapy and 10 patients of less than 2 mm diameter of stone under medical expulsion therapy. RESULT Outdoor- The medical expulsion therapy performed in less than 2 mm diameter stone of patient. The success rate is 98% and failure rate is 2%. Indoor- Patient wise analysis was done. Stones were 2 mm diameter to 20 mm diameter. Number of shockwaves from 2500 to 3000 MA was given. Breaking rate are 65% to 75%. Character of stones were firm and hard. Presence of fragment- Nil. Followup patient- 75%. Forced diuresis by diuretics, hydrostatic pressure and osmotic pressure and Medical Expulsion Therapy were given. 95% was successful and 5% was failure. Need for reformation of stone- Nil. Session- Single. Cost- Same cost, no extra cost. CONCLUSION ESWL with Diuresis and Medical Expulsion Therapy to remove the concretion is an effective option for microparticles and crystal clearance. This is not an invasive therapy, might be a valuable alternative to the various invasive management modalities like Conventional Surgery, PCNL, URS and Endoscopy
Authors and Affiliations
Ram Nagina Sinha
Keywords
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- EP ID EP225786
- DOI 10.14260/Jemds/2017/878
- Views 90
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