EFFECTS OF PREVIOUS UNSUCCESSFUL EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY TREATMENT ON THE PERFORMANCE AND OUTCOME OF PERCUTANEOUS NEPHROLITHOTOMY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 75
Abstract
BACKGROUND Majority of renal stones diagnosed today are below 2 cm, perhaps due to easy and early accessibility to x-ray and ultrasonography. The preferred treatment of < 1 cm stone is extracorporeal shockwave lithotripsy (ESWL), while standard of care for renal stone > 2 cm is percutaneous nephrolithotomy (PCNL). The procedure of choice for 1 - 2 cm renal stones is still a subject of debate. Controversy exists with regard to optimum management of these stones by percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) with reference to stone clearance, hospital stay and complications. The primary goal while treating renal stones is to achieve complete clearance, while causing minimal morbidity to the patient. Treatment of renal stone depends on stone size and location plus patient related factors including anatomy of pelvicalyceal system. In our study, previous ESWL treatment had no influence on the PCNL stone-free rate, operation time, incidence of postoperative complications and LOS in patients with similar stone burdens. However, bleeding during PCNL was more prevalent in the ESWL-treated patients, so close attention should be paid to bleeding in patients who have been pretreated with ESWL. The objective of this study is to evaluate the effects of previous unsuccessful extracorporeal shockwave lithotripsy (ESWL) treatment on the performance and outcome of percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS Of 115 PCNL procedures performed in our institute with similar stone burden and number of accesses was included in the present study. We categorised the study patients into two groups according to whether they underwent ESWL within 1 year prior to PCNL or not. Accordingly, Group 1 comprised of 42 (36.5%) ESWL-treated patients and Group 2 comprised of 73 (63.4%) non-ESWLtreated patients. RESULTS There were no statistically significant differences between the groups for length of hospital stay (LOS), nephrostomy tube removal time and the presence of residual stones. When we evaluated the groups for both the preoperative and postoperative haemoglobin (Hb) drop and blood transfusion rate, manifest Hb declined and more transfusions were required in the ESWL-treated patients (both P= 0.01). CONCLUSION Many patients who undergo PCNL have undergone ESWL treatment beforehand. The renal side-effects of ESWL are well known, the duration of which varies between studies. In the present study, we found that previous ESWL had an effect on bleeding during the PCNL procedure.
Authors and Affiliations
Anshul Garg, Kumar Gaurav Mishra, Pawan Kumar Bharti, Urvashi Mishra
Keywords
Related Articles
- EP ID EP266973
- DOI 10.14260/Jemds/2017/1172
- Views 97
- Downloads 0
EVALUATION OF GENE XPERT ASSAY IN EXTRAPULMONARY TUBERCULOSIS IN CHILDREN
BACKGROUND Tuberculosis constitutes the main infectious cause of death worldwide. Extra-pulmonary tuberculosis (EPTB) accounts for up to sixty percent of all cases of childhood tuberculosis. In high burden countries like...
INTESTINAL PARASITES IN PATIENTS HAVING HAEMATOLOGICAL MALIGNANCIES
BACKGROUND Haematological malignancies like leukaemia, lymphoma and myeloma originate in the bone marrow, lymph nodes which may be acute and chronic. These patients receive immunosuppressive agents, which put t...
CORRELATION OF ULTRASONOGRAPHY FINDINGS OF WALL PATTERN AND DISCONTINUITY OF WALL WITH PER-OPERATIVE FINDING FOR PERFORATION OF APPENDIX
BACKGROUND Ultrasonography is widely used for diagnosis of appendicitis.[1-4] There have been not much literature for diagnosing perforated appendicitis by evaluating wall pattern and wall thickness by USG. In this study...
HOPE AND SPIRITUAL WELL-BEING IN IRANIAN PATIENTS UNDERGOING CHEMOTHERAPY
BACKGROUND Cancer is a major well-being problem worldwide. Chemotherapy is one of the main therapeutic and systemic interventions of cancer. Hope is one of the most important factors in battling against cancer and its co...
PATTERN OF SUBSTANCE USE IN A DRUG DEADDICTION CENTRE IN DIPHU- NORTHEAST INDIABASED STUDY
BACKGROUND India is a multicultural and multilingual democracy; the use of different substances is found to be regionally diversified. Ethnic variations have contributed to this diversification and so a single study on a...