Abstract

Aim: To compare the stone clearance rate in ureteric stones after ureterorenoscopy / lithoclast between patients

with and without percutaneous nephrostomy.

Methods After the approval from Ethical committee KEMU this randomized clinical trial was conducted at

department of Urology (unit I and unit II), Mayo Hospital Lahore. Sample size of one hundred fifty patients

seventy five patients in each group) was estimated. Group A contained patients with upper ureteric stones and

having percutaneous nephrostomy due to presence of lumber pain resistant to medical treatment, varying degree

of hydroneph rosis due to obstructed uropathy and acceptance of procedure and underwent ureterorenoscopy with

pneumatic lithoclast. Group B contained patients with upper ureteric stones with presence of lumber pain and

varying degree of hydronephrosis without percutane ous nephrostomy and nephrostomy was not performed and

underwent ureterorenoscopy.

Results: In current study the mean age of all patients was 35.79±13.14 whereas the mean age in group A a s well

as Group B was 33.77±12.57 years and 37.81±13.47 years respect ively, the mean age was statistically same in

both groups, p value> 0.05. In current study t here were 102(68%) male and 48(32%) female cases, the male to

female ratio was 2.15:1. In current study the mean operative time in group A was 61.72±12.14 minutes and in

group B was 28.87±9.04 minutes with statistically lesser mean operative time in group B, p value <0.05.

Conclusion: Results of this study showed that stone clearance rate was significantly higher in URS/Lithoclast

without PCN when compared with URS /Lithoclast with PCN patients. i. 94.7% vs. 80%, p value=0.007 because

hydrostatic pressure and, mucosal edema of the ureter wall are the most important factors in higher stone

clearance rate in group B. In our study drainage of collecting system with PCN has reduced the redundancy of

ure ter proximal to the obstruction and reduced the mucosal edema within the ureter in case of impacted stone and

relatively large stone. The operative time was also less for Group B when compared it with Group A. Hence, in

future URS/Lithoclast alone can be e ffectively used to treat patients presenting with upper ureteric stones.

Keywords:

Percutaneous nephrolithotomy, nephrolithotripsy, SWL, Tubeless, hospital stay.