Study of clinical indication, difficulties and complications of DJ stenting in urological procedure at a tertiary hospital

2021 ◽  
Vol 19 (2) ◽  
pp. 53-57
Author(s):  
Vidyadhar P Kelkar ◽  
Keyword(s):  
Tertiary Hospital ◽  
Stone Disease ◽  
Clinical Indication ◽  
Ureteral Stones ◽  
Stent Insertion ◽  
Stone Size ◽  
Ureteric Calculi ◽  
Dj Stent ◽  
Ureteral Stenting ◽  
Ureteric Stricture

Background: Urolithiasis is one of the major causes of morbidity in our society as our country is located near to equatorial distribution of stone disease Indwelling ureteral stents provide free drainage from the kidney to the bladder, reduce or eliminate urinary leakage and provide ureteral stenting. The present study was designed to observe indications, difficulties and complications of indwelling double J ureteral stenting. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients undergoing DJ stenting URS/ESWL (stone size > 2cm), willing to participate in study. The data collected was entered into Microsoft excel and analyzed. Statistical analysis was done using descriptive statistics. Results: In the present study, we assessed prospectively the effectiveness of DJ stent insertion for treatment of ureteral stones in 100.patients. Gender distribution in the current study was 65% male and 35 % female. 65 % patients were between the age 10 to 40 years; 20 patients have lower ureteric calculi, 37 patient having mid ureteric calculi and 8 patients having upper ureteric calculi. In current study out of 100 patients 32 patients have stone between the range of 6-10 mm, 42 patients have stone size range between 11-16 mm and only 26 patient have stone size more than 16 mm. 32 patients having mid ureteric calculi in which 30 patients DJ stent procedure successfully completed, remaining 2 patients had ureteric stricture treated with URSL. 27 patients having lower ureteric calculi in which 25 patients DJ stent procedure successfully completed, remaining 2 patient had ureteric stricture treated with ESWL followed by cystoscopy removal. 8 patients having bilateral ureteric calculi in which 6 patients DJ stent procedure successfully completed, remaining 2 patient have impacted stone treated with URSL with PCNL. 100% success rate in DJ stent insertion in patients with stone size 11-16mm followed by in 93% with stone size 6-10mm and in 76% with stone size >16mm. Conclusion: Most of the ureteral DJ stent related complications can be managed by surgical procedures hence they should be removed as soon as their purpose solves. The proper follow up from patients can help to early identification of post insertion complications of DJ stent and timely management of them.

scholarly journals The impact of ureteral Double-J stent insertion following ureterorenoscopy in patients with ureteral stones accompanied by perirenal fat stranding

2018 ◽  
Vol 90 (1) ◽  
pp. 15
Author(s):  
Ercan Ogreden ◽  
Ural Oguz ◽  
Erhan Demirelli ◽  
Erdal Benli ◽  
Özkan Özen
Keyword(s):  
Ureteral Stone ◽  
Ureteral Stones ◽  
Stent Insertion ◽  
Female Ratio ◽  
Group I ◽  
Dj Stent ◽  
Group Ii ◽  
Fat Stranding ◽  
The Impact ◽  
Perirenal Fat

Objective: To evaluate the impact of ureteral stent insertion following semirigid ureterorenoscopy (URS) in patients with perirenal fat stranding (PFS) due to ureteral stones. Material and methods: Data of 600 patients who underwent URS were analyzed retrospectively. Seventy-two patients detected to have PFS accompanying ureteral stone were included. Patients who did not undergo double J (DJ) stent insertion following semirigid URS were classified as Group I (n: 52), while those who underwent stent insertion were classified as Group II (n: 20). Side distribution; localization of the stones, stone size, presence of fever, urinary tract infection (UTIs) and urosepsis rates were compared in the two groups. Results: The average age of the patients was 44.4 (20-71) years. Male/female ratio and side of the stone location showed similar distribution in both groups (p > 0.05). Fever occurred in 23 cases (44.2%) in Group I and in 15 cases (75%) in Group II (p = 0.038). UTIs occurred in 15 cases (28.9%) in Group I and in 12 cases (60%) in Group II (p = 0.03). Urosepsis presented in 3 (5.8%) and 5 (25%) of the patients in Group I and II, respectively (p = 0.033). Conclusions: According to our results, ureteral DJ stent insertion following URS in patients with PFS due to ureteral stone caused an increase on postoperative infection related complications.

Comparative Analysis of Semi Rigid Ureterolithotripsy and Extracorporeal Shock Wave Lithotripsy for the Treatment of Upper Ureteric Calculi

2020 ◽  
Vol 20 (2) ◽  
pp. 54-60
Author(s):  
Atm Aman Ullah ◽  
Isteaq Ahmed Shameem ◽  
Akm Khursidul Alam ◽  
Md Golam Mowla Chowdhury ◽  
Akm Anwarul Islam ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Repeated Treatment ◽  
Stone Size ◽  
Chi Square ◽  
Extracorporeal Shock Wave ◽  
Ureteric Calculi ◽  
Urological Complications ◽  
Stone Migration ◽  
Chi Square Test ◽  
Dj Stent

Objectives: To find out the better treatment option between semi rigid ureteroscopy with ICPL and ESWL for upper ureteric calculi. To compare stone free rate, complications and re treatment between ureterolithotripsy and ESWL in upper ureteric calculi. Materials and Method: This prospective comparative study was conducted in the department of urology BSMMU and Kidney and urology hospital, Dhaka from June 2009 to May 2010. Fifty patients were enrolled and 25 on each group as ESWL and ICPL Inclusion criteria was adult patients with single radiopaque stone of 06-15 mm, and no obstruction distal to stone. We exclude Stone size > 1.5cm, PUJ stone, patients with DJ stent and nephrostomies, infection, pregnancy, hemostatic, disorders, and morbid obesity. Identified postoperative urological complications pain, haematuria, fever, stone migration, obstruction, infections, and postoperative hospital stays recorded accordingly. X- ray KUB and in some cases ultrasound of kidney ureter and bladder with prostate with PVR were done. Those with residual calculi sized less than 2 mm were considered stone free. Those patients whom stone not cleared or stone migrated they again sent for ESWL or ureterolithotripsy. Stone free patient of ureterolithotripsy sent for removal of Double J stent under local anesthesia at 4 weeks. Results: Three months postoperatively, 21 out of 25 Patients (85%) in the ureterolithotripsy group were stone free. In ureterolithotripsy group, all failures were due to upward calculus migration. After calculus migration, this was mandated double- J stenting and send for ESWL. These patients were referred for ESWL, all of whom were stone free after this procedure. DJ stent removed under local anesthesia. 22 out of 25 Patients (88%) in the ESWL group were stone free and 10 patients need two sessions. Re-ESWL had done after 3 weeks. All failures in ESWL group were due to hard in constancy and small stone size. Failed cases were referred for ureterolithotripsy and DJ stenting, all of whom were stone free after this procedure. Using statistical data by chi square test and analytical test level of significance as set at 0.05 and p< 0.05 was consider significant. Conclusion: Upper ureteral calculi up to 1.5 cm can be safely and effectively managed by using semi rigid ureteroscopy and pneumatic lithotripsy. However, the ESWL approach has still its role in treating upper ureteric calculi. Finally, postoperative home rest in the ESWL group was more due to the repeated treatment. Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.54-60

scholarly journals Single centre study of stone clearance with ureterorenoscope & lithoclast for ureteric calculi; our experience.

2019 ◽  
Vol 26 (08) ◽  
pp. 1296-1299
Author(s):  
Qazi Adil Inam ◽  
Furqan Arshad ◽  
Nabeel Naeem Baig ◽  
Khadijah Abid
Keyword(s):  
Ureteral Stones ◽  
Ureteric Stone ◽  
Single Centre ◽  
Stone Size ◽  
Stone Clearance ◽  
Ureteric Calculi ◽  
Single Centre Study ◽  
Stone Treatment ◽  
Study Setting ◽  
Clearance Study

To decide the adequacy of ureterorenoscope by utilizing lithoclast for distal ureteric stone clearance. Study Design: Longitudinal study. Setting: Department of urology Aziz Bhatti Shaheed Teaching Hospital. Period: Feb 2014 to Dec 2016. Materials and Methods: 32 patients from medical record who underwent for stone clearance with ureteroscopy followed by lithoclast. The patients with larger upper ureteral stones were enrolled in the study though patients with stone size<1cm and co-morbidities were not included in the study. The characteristic of patients and stone, treatment modality & outcome i.e. efficacy in terms of “successful stone clearance” were determined. Results: The average age of 32 patients was 34.28±10.11 years. 18 (56.3%) of the patients were females whereas 14 (43.7%) were males. Ureteric stones were present on both right and left sides in 17 (54%) and 15(46%) patients. Bilateral ureteric stone was present in 2 (6.25%) patients. The efficacy was reported as 96% for the stone size of 1-1.5cm and 92% for the stone size of 1.6-3cm. Conclusions: We concluded that Ureterorenoscope followed by Lithoclast is the useful and safest procedure for stone clearance.

scholarly journals Ureterorenoscopy, a review of first three years of experience for ureteric stone disease.

2019 ◽  
Vol 26 (10) ◽  
pp. 1712-1718
Author(s):  
Saif Ud Din Awan ◽  
Ahmad Nawaz Bhatti ◽  
Ayesha Naureen Awan
Keyword(s):  
Open Surgery ◽  
Stone Disease ◽  
Therapeutic Modality ◽  
Excessive Force ◽  
Distal Ureter ◽  
Medical College ◽  
Ureteric Calculi ◽  
Dj Stent ◽  
Average Size ◽  
Excellent Tool

Objectives: Ureterorenoscopy is a diagnostic and therapeutic modality, used for different ureteral and renal pathologies. It has virtually replaced open surgery for ureteric calculi. Study Design: Observational. Setting: Urology Department of Sargodha Medical College, Sargodha. Period: 2011-2015. Material and Methods: All cases who underwent URS for stone disease during the study period were included in the study. The initial criterion was a bit strict, due to minimum experience, which limited only clinically fit patients with no co-morbid illnesses, with stone size of 1 cm or less, located in middle or preferable in distal ureter, single stone was also preferred, but later the criterion was relaxed with gain confidence. The procedures were performed under general anesthesia using R Wolf Ureterorenoscope. Results: The total number of cases included in the study were 332 of which 189 were males and 143 were females. Average age being 42.82 years. The total number of stones managed were 354 (in 22 cases the stones were bilateral). The average size of stones was 1.2 cm. DJ stent was used in 78 cases. Complications were observed in 14.76 percent cases (2.71% major and 12.05% minor). No deaths occurred in the study group. Conclusion: Uretero renoscopy is an excellent tool for the management of ureteral stone disease so much so that these cases, after sufficient experience, can be managed as day cases. The complication rate can be controlled by careful patient selection. Being intuitive and stopping the procedure on the very first hint of something going wrong like the scope being stuck or requiring excessive force. Strictures should not be traversed without adequate prior dilatation. The operator should have sufficient experience with open surgery.

Outcome of Upper Ureteric Stone Management by Semirigid Ureterorenoscope and Intracorporeal Pneumatic Lithotripsy

2020 ◽  
Vol 16 (2) ◽  
pp. 47-50
Author(s):  
Md Ruhul Quddus ◽  
Md Asaduzzaman ◽  
Md shariful Islam ◽  
Kaiser Ahmed ◽  
MA Awal ◽  
...  
Keyword(s):  
Kidney Diseases ◽  
Guide Wire ◽  
Ureteral Injury ◽  
Ureteric Stone ◽  
Stone Clearance ◽  
Stone Fragment ◽  
Ureteric Calculi ◽  
Ureteric Orifice ◽  
Distal Obstruction ◽  
Ureteric Stricture

Objective: To evaluate the outcome of upper ureteric stone management using semirigid URS + ICPL. Materials and Methods: Patients undergoing URS + ICPL in patient department were included in the study. Total 38 patient were included in the study from March 2009 to June 2010 in National Institute of Kidney diseases & Urology, Dhaka. Stone size was 8 mm to 1.5 cm, patients were with good renal function, well excreation on both side, without any distal obstruction, infection or multiple ureteric calculi. The procedure was done under SAB.Cystoscopy was done for identification of ureteric orifice and guide wire was passed within ureteric orifice under visual monitoring.46 cm 10 Fr Storz Uretroscope was advanced next to the guide wire.At time a tortuous portion of the ureter was encountered a second guide wire was helpful. As soon as the stone was seen the pneymatic probe was pushed toward the stone.After fixing to the stone, pneumatic source was on and stone fragmentation was started. Care was taken to avoid injury of the ureter and keeping eye one stone fragment migration within the ureter was achieved. Placement of D-J stent was done at the conclusion of the procedure in most of the cases Result: The patients were followed upto 3 months post-operatively. Within immediate complications fever occured in 10 (26.3%) patients, severe haematurea occured in 8 (21.3%) patients, ureteral injury in 8 (21.3%) & ureteric perforation in 2 (4.8%) patients underwent URS+ ICPL. Stone clearance rate after 01 month of intervention was 30 (78.9%). Almost half of the patients developed UTI after 01 month of intervention. Pyelonephritis occured in 2 ( 4.8%) patient in this group. After 03 months of intervention 84.2% patients exibited complete clearance of stone. Only 02 (4.8%) patients developed ureteric stricture. Conclusion: For management of selective sized upper ureteric stone ureterorenoscopy with semirigid one using pneumatic source of energy is a good option for it’s high stone clearance & resonably low complications. Bangladesh Journal of Urology, Vol. 16, No. 2, July 2013 p.47-50

Detection of Ureteral Stones in Kidney Ureter Bladder Radiography: Usefulness of Digital Post-processing

2021 ◽  
Vol 17 ◽  
Author(s):  
Sang Lim Choi ◽  
Sung Bin Park ◽  
Seungwook Yang ◽  
Eun Sun Lee ◽  
Hyun Jeong Park ◽  
...  
Keyword(s):  
Detection Sensitivity ◽  
Ureteral Stones ◽  
Data Sets ◽  
Post Processing ◽  
Stone Size ◽  
Data Set ◽  
Detection Rates ◽  
Exact Test ◽  
Significant Difference ◽  
Exact Size

Purpose: Kidney, ureter, and bladder radiography (KUB) has frequently been used in suspected urolithiasis, but its performance is known to be lower than that of computed tomography (CT). This study aimed to investigate the diagnostic performance of digitally post-processed kidney ureter bladder radiography (KUB) in the detection of ureteral stones. Materials And Methods: Thirty patients who underwent digital KUB and CT were included in this retrospective study. The original digital KUB underwent post-processing that involved noise estimation, reduction, and whitening to improve the visibility of ureteral stones. Thus, 60 digital original or post-processed KUB images were obtained and ordered randomly for blinded review. After a period, a second review was performed after unblinding stone laterality. The detection rates were evaluated at both initial and second review, using CT as reference standard. The objective (size) and subjective (visibility) parameters of ureteral stones were analyzed. Fisher’s exact test was used to compare the detection sensitivity between the original and post-processed KUB data set. Visibility analysis was assessed with a paired t-test. Correlation of stone size between CT and digital KUB data sets was assessed with Pearson’s correlation test. Results: The detection rate was higher for most reviewers once stone laterality was provided and was non-significantly better for the post-processed KUB images (p > 0.05). There was no significant difference in stone size among CT and digital KUB data sets. In all reviews, visibility grade was higher in the post-processed KUB images, irrespective of whether stone laterality was provided. Conclusion: Digital post-processing of KUB yielded higher visibility of ureteral stones and could improve stone detection, especially when stone laterality was available. Thus, digitally post-processed KUB can be an excellent modality for detecting ureteral stones and measuring their exact size.

scholarly journals Extracorporeal Shockwave Lithotripsy in the Management of a Large Proximal Ureteric Stone: A Case Report

1970 ◽  
Vol 1 (2) ◽  
pp. 70-73
Author(s):  
Mohammad A H Aly Freeg ◽  
Anu V Ranade ◽  
Jayakumary Muttappallymyalil ◽  
Tarek F A Ghaffar
Keyword(s):  
Anatomical Variations ◽  
Urinary Stone ◽  
Stone Disease ◽  
Extracorporeal Shockwave Lithotripsy ◽  
Ureteral Stones ◽  
Shockwave Lithotripsy ◽  
Ureteric Stone ◽  
Extracorporeal Shockwave ◽  
High Prevalence ◽  
Acute Flank Pain

Urinary stone disease still persists as a major health care problem due to its high prevalence. The management of patients with ureteral stones still remains under debate in several areas. There are different therapeutic approaches for ureteral stones depending on stone size, location, anatomical variations of the urogenital tract and patient performance. Extracorporeal shockwave lithotripsy (ESWL) being the main stay of treatment of choice for the stones, the management of large stone remains a point of discussion. With the latest advance in technology coupled with knowledge, there have been recent changes in therapeutic options for ureteric stones. Therefore, the treatment approaches may be individualized in order to achieve optimum outcomes. This article reports on a case of a large proximal ureteric stone with acute flank pain and hematuria managed by ESWL. Key words: Urinary stone; Ureteric stone; ESWL.DOI: http://dx.doi.org/10.3126/nje.v1i2.5144 Nepal Journal of Epidemiology 2011;1 (2):70-73

scholarly journals Do stone size and impaction influence therapeutic approach to proximal ureteral stones?

2009 ◽  
Vol 66 (2) ◽  
pp. 129-133 ◽  
Author(s):  
Slobodan Radulovic ◽  
Aleksandra Vuksanovic ◽  
Dragica Milenkovic-Petronic ◽  
Bozo Vavic
Keyword(s):  
Therapeutic Approach ◽  
Ureteral Stone ◽  
Treatment Success ◽  
Ureteral Stones ◽  
Stone Size ◽  
Extracorporeal Shock Wave ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Proximal Ureteral Stone

Background/Aim. Primary therapeutic approach to lumbar ureteral stones is still contraversial. The aim of the study was to investigate the influence of stone impaction and size on the effectiveness of proximal ureteral stone lithotripsy. Methods. A total of 123 patients with proximal ureteral stones were investigated in this prospective study performed in a 10- month period. The patients were divided into the group I - 86 patients treated with extracorporeal shock wave lithotripsy (ESWL) and the group II - 37 patients treated with 'Swiss' Lithoclast. In the group I, 49 stones (57%) were classified as impacted, while 20 stones (23.3%) were larger than 100 mm2. In the group II, 26 stones (70.3%) were impacted, and 11 stones (29.7%) were larger than 100 mm2. Stones were defined as impacted by the radiographic, echosonographic as well as endoscopic findings in the group II of patients. Stone size was presented in mm2. Chemical composition of stones were almost the same in both groups of the patients. Results. Generally, there was no statistically significant difference in the treatment success between the groups. However, stones larger than 100 mm2 were statistically more successfully treated endoscopically, while there was no statistical difference in the treatment success of impacted stones between these two groups. Conclusion. ESWL can by considered as primary first therapeutic approach in treatment of all proximal ureteral stones except for stones larger than 100 mm2 that should primarily be treated endoscopically.

scholarly journals A Case of Laparoscopic Ureteric Reimplantation in a Solitary Urinary System

2014 ◽  
Vol 5 (1) ◽  
pp. 39-43
Author(s):  
Karl H. Pang ◽  
Saiful Miah ◽  
Mark D. Haynes ◽  
Neil E. Oakley
Keyword(s):  
Treatment Options ◽  
Solitary Kidney ◽  
Stone Disease ◽  
Pelvic Surgery ◽  
Urinary System ◽  
Ureteric Reimplantation ◽  
Ureteric Stenting ◽  
Preserve Renal Function ◽  
History Of ◽  
Ureteric Stricture

Ureteric strictures can be caused by traumatic pelvic surgery, urolithiasis and instrumentation. There are various treatment options for ureteric stricture, including laparoscopic ureteric reimplantation. A 56-year-old female with a history of chronic left pelviureteric junction obstruction presented with urosepsis secondary to right-sided urolithiasis. The patient had a left nephrectomy and developed right-sided ureteric stricture following repeated ureteroscopy to manage her stone disease. The treatment with ureteric stenting was unsuccessful. Here we present a case on the feasibility of laparoscopic reimplantation for ureteric stricture in a solitary kidney to preserve renal function and avoid further ureteroscopy or nephrostomies.

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