Management of Calculus Anuria Using Ureteroscopic Lithotripsy as a First Line Treatment: Its Efficacy and Safety
Aftab Ahmed Channa, Nauman Ahmed, Muhammad Asif, Mhammad Zahid Ahmed, Muhammad Waqar Shahid, Fazal E Nauman
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ABSTRACT
Purpose: To
present our experience with emergency ureteroscopic lithotripsy (URSL) on
ureteral stones related with acute kidney injury (AKI).
Place and Duration: In the Department of Urology for three years duration from
January 2019 to January 2020.
Material and methods: We retrospectively analysed 27 patients consisting of 54 ureteral units
(UU) undergoing URSL. There were 9 females and 18 males with M: F of 2:1 The
anuria cause was bilateral obstruction with calculi in 21 cases, and unilateral
obstruction with calculi in 33 cases with contralateral nephrectomy. In the
same session, bilateral ureteroscopy was performed for bilateral synchronous
ureteral stones. The anuria duration ranged from 12hours to 3-days. After the
procedure, all patients ureteral stent were systematically removed. The
operation was accomplished 6-12 hours afterward hospitalization. After surgery;
all individuals were followed for minimum one-month.
Results: A
total of 27 urgent URSL were performed in 9 (33.3%) females and 18 (66.7%) males
with an average age of 51 (range 32 to 73). Percutaneous nephrostomy was
performed in 2 (7.4%) patients and in 2 (9.5%) patients with bilateral stones,
the ureteral units (UU), severely wedged distal hard stones. These patients
were candidates for open surgery, ureterolithotomy, 6 to 8 weeks afterward the initial
intervention (PCN+ URSL). The improvements in renal function as demonstrated by
post-obstruction diuresis and serum creatinine were compared in the two groups
of patients using the Fisher's exact test. In 20 (71.1%) patients, URSL proved
to be an effective therapeutic approach for obstruction removal and stone
removal. Repeat surgery was required in 3 (11.1%). In 3 (11.1%) patients, URSL
caused significant damage to the mucosa with a guide wire in the area of the
damaged ureteral calculus. Ureteral stenting was sufficient to treat this
complication. Stone or fragment migration was observed in 5 (18.5%) patients,
all of which were in the upper stone position, and this procedure was the main reason
of failure. In the first 24 hours, mild macroscopic haematuria was detected
which did not require treatment. Postoperatively, 6 (22.2%) patients had high
fever. Body temperature reversed back to usual within four days after getting
the high dose and intravenous injection of a third-generation cephalosporin
antibiotic (ureteral stent culture for Escherichia coli and positive urine
culture).
Conclusion: Calculus
anuria is a therapeutic emergency that necessitates timely analysis and
decompression management. URSL is the appropriate technique for designated
patients and can be accomplished securely and has a high achievement rate with insignificant
incidence of morbidity.
Key words: Ureteral stones,
ureteroscopy; surgery; kidneys, anuria, abnormalities; outcome and treatment
ABSTRACT
Purpose: To
present our experience with emergency ureteroscopic lithotripsy (URSL) on
ureteral stones related with acute kidney injury (AKI).
Place and Duration: In the Department of Urology for three years duration from
January 2019 to January 2020.
Material and methods: We retrospectively analysed 27 patients consisting of 54 ureteral units
(UU) undergoing URSL. There were 9 females and 18 males with M: F of 2:1 The
anuria cause was bilateral obstruction with calculi in 21 cases, and unilateral
obstruction with calculi in 33 cases with contralateral nephrectomy. In the
same session, bilateral ureteroscopy was performed for bilateral synchronous
ureteral stones. The anuria duration ranged from 12hours to 3-days. After the
procedure, all patients ureteral stent were systematically removed. The
operation was accomplished 6-12 hours afterward hospitalization. After surgery;
all individuals were followed for minimum one-month.
Results: A
total of 27 urgent URSL were performed in 9 (33.3%) females and 18 (66.7%) males
with an average age of 51 (range 32 to 73). Percutaneous nephrostomy was
performed in 2 (7.4%) patients and in 2 (9.5%) patients with bilateral stones,
the ureteral units (UU), severely wedged distal hard stones. These patients
were candidates for open surgery, ureterolithotomy, 6 to 8 weeks afterward the initial
intervention (PCN+ URSL). The improvements in renal function as demonstrated by
post-obstruction diuresis and serum creatinine were compared in the two groups
of patients using the Fisher's exact test. In 20 (71.1%) patients, URSL proved
to be an effective therapeutic approach for obstruction removal and stone
removal. Repeat surgery was required in 3 (11.1%). In 3 (11.1%) patients, URSL
caused significant damage to the mucosa with a guide wire in the area of the
damaged ureteral calculus. Ureteral stenting was sufficient to treat this
complication. Stone or fragment migration was observed in 5 (18.5%) patients,
all of which were in the upper stone position, and this procedure was the main reason
of failure. In the first 24 hours, mild macroscopic haematuria was detected
which did not require treatment. Postoperatively, 6 (22.2%) patients had high
fever. Body temperature reversed back to usual within four days after getting
the high dose and intravenous injection of a third-generation cephalosporin
antibiotic (ureteral stent culture for Escherichia coli and positive urine
culture).
Conclusion: Calculus
anuria is a therapeutic emergency that necessitates timely analysis and
decompression management. URSL is the appropriate technique for designated
patients and can be accomplished securely and has a high achievement rate with insignificant
incidence of morbidity.
Key words: Ureteral stones,
ureteroscopy; surgery; kidneys, anuria, abnormalities; outcome and treatment