Keywords : renal stone


Feasibility and Efficacy of Percutaneous Nephrolithotomy, Initial Experience

Ammar Fadil Abid

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 334-337

ABSTRACT:
BACKGROUND:
Renal stone disease is common in Iraqi population and percutaneous nephrolithoyomy present a minimal access for large stone a substitute for traditional open surgery
OBJECTIVE:
We are presenting our first experience in percutaneous nephrolithotomy )PCNL( in terms of renal access, stone free and to evaluate the other aspects such as the need of auxiliary procedures in a center without prior experience in this field.
MATERIALS AND METHODS:
We evaluate all the PCNL performed in period of two year. A series of perioperative and post-operative details were recorded. All PCNL were performed in prone position.
RESULTS:
The first 55 PCNL cases were included in the study. Out of 55 patients, 16 were women and 39 men. Their mean age was 35.5 years (range 11-65) and means stone diameter were 23.5 mm ± 8.9. A successful renal access achieved in 87.3 % (48) cases with stone fragmentation. Procedures were performed over two year Dec.2013-Dec. 2015. Of fifty five patients 4 cases with single functioning kidney, and eleven cases with PCNL on same side of previous scar of pyelolithotomy. Stone free rate was 82%. Co morbidities included 8 hypertensive, 3 diabetics, one systemic lupus erythematosus and two with elevated blood urea.
Morbidity and complications following PCNL are dominated by access failure in 12.7 % (n= 7); intraoperative bleeding in 3.6 % (n=2), urinary leakage in one patient, ureteric colic in 5.4 % (n=3) hydrothorax 1.8 % (n=1). None of these patients experienced post-operative bleeding, No mortality
CONCLUSION:
PCNL can be learned by urologists who do not have the support of an experienced colleague without endangering patient safety.

Effect of Shock Wave Frequency on Treatment Outcomes in Patients with Renal Stone Treated by Extracorporeal Shock Wave Lithotripsy

Hasan Ali Rasheed; Samir Ali Muter; Ziad Hammad Abd; Noorulhuda Mukhlif Najm Al-Ani

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 2, Pages 197-202

ABSTRACT:
BACKGROUND:
since the introduction of ESWL in treatment of renal stones, it remained the first option for most renal and ureteric stones, with a success rate ranging from 60% to 90%. Multiple variables can affect treatment outcome, including those related to the machine, dose administered, and factors related to the patient; the exact role of most of these factors is still under study.
OBJECTIVE:
We investigated the effect of shock wave frequency on treatment outcomes in terms of success and complication rates.
PATIENTS AND METHOD:
139 patients with radio-opaque renal stones, presented to the Urology consultancy clinic during the period June 2010 through January 2012 and decided to undergo ESWL treatment were randomized into three groups, the first group (46 patients) received shock waves at a frequency of 120 waves per minute, the second (47 patients) at 90 w/m, and the third group (46 patients) at 60 w/m. Patients were followed for treatment outcome and appearance of complications at 1 week, 3 weeks, and 6 weeks. Stone free status or insignificant asymptomatic residual gravels of 5mm or less are considered as success. Durations of hematuria and analgesic requirement were the main complications looked for during follow up, while subcapsular and retroperitoneal hematomas were looked.
RESULTS:
All patients received 3500-4000 shock waves per session at 17-18 KV energy. Success rate was significantly higher in the second and third groups, while the durations of hematuria and analgesic requirement were significantly shorter in groups 2 and 3. There was no significant difference between groups 2 and 3 in all outcome and complication parameters; however, the duration of treatment was significantly longer in groups 2 and 3.
CONCLUSION:
ESWL efficacy in fragmenting renal stones is significantly improved by decreasing frequency from the standard 120 sw/min to slower rates (90 and 60 sw/min), with significantly decreased analgesic requirement and hematuria durations. There were no significant differences between the 60 and 90 sw/min frequencies. Taking in account the longer treatment duration for the 60 sw/min frequency; the 90 sw/min frequency would be optimal in terms of stone disintegration, complications, and duration of treatment.
KEY WORDS: ESWL, renal stone.

Effect of Shock Wave Frequency on Treatment Outcomes in Patients with Renal Stone Treated by Extracorporeal Shock Wave Lithotripsy

Samir Ali Muter; Ziad Hammad Abd; Hasan Ali Rasheed; Noorulhuda Mukhlif Najm Al-Ani

Iraqi Postgraduate Medical Journal, 2015, Volume 14, Issue 2, Pages 197-202

ABSTRACT:
BACKGROUND:
since the introduction of ESWL in treatment of renal stones, it remained the first option for most renal and ureteric stones, with a success rate ranging from 60% to 90%. Multiple variables can affect treatment outcome, including those related to the machine, dose administered, and factors related to the patient; the exact role of most of these factors is still under study.
OBJECTIVE:
We investigated the effect of shock wave frequency on treatment outcomes in terms of success and complication rates.
PATIENTS AND METHOD:
139 patients with radio-opaque renal stones, presented to the Urology consultancy clinic during the period June 2010 through January 2012 and decided to undergo ESWL treatment were randomized into three groups, the first group (46 patients) received shock waves at a frequency of 120 waves per minute, the second (47 patients) at 90 w/m, and the third group (46 patients) at 60 w/m. Patients were followed for treatment outcome and appearance of complications at 1 week, 3 weeks, and 6 weeks. Stone free status or insignificant asymptomatic residual gravels of 5mm or less are considered as success. Durations of hematuria and analgesic requirement were the main complications looked for during follow up, while subcapsular and retroperitoneal hematomas were looked.
RESULTS:
All patients received 3500-4000 shock waves per session at 17-18 KV energy. Success rate was significantly higher in the second and third groups, while the durations of hematuria and analgesic requirement were significantly shorter in groups 2 and 3. There was no significant difference between groups 2 and 3 in all outcome and complication parameters; however, the duration of treatment was significantly longer in groups 2 and 3.
CONCLUSION:
ESWL efficacy in fragmenting renal stones is significantly improved by decreasing frequency from the standard 120 sw/min to slower rates (90 and 60 sw/min), with significantly decreased analgesic requirement and hematuria durations. There were no significant differences between the 60 and 90 sw/min frequencies. Taking in account the longer treatment duration for the 60 sw/min frequency; the 90 sw/min frequency would be optimal in terms of stone disintegration, complications, and duration of treatment.

Shock Wave Lithotripsy for Medium to Large Renal Pelvic Stone Without Ureteral Stent

Ammar Fadel Abid

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 2, Pages 180-183

ABSTRACT:
BACKGROUND:
Although Double J ureteral stent placement has been widely used to prevent steinstrasse after fragmentation of larger stones. But, particularly more recently, its preventive efficacy has been questioned.
OBJECTIVE:
It is to determine that patients with medium to large renal pelvic stone should be treated in situ shock wave lithotripsy without auxiliary stenting.
PATIENTS & METHODS:
Between October 2007 and December 2008 a series of 55 patients with unilateral renal pelvic stone with at least one diameter between 15 and 30mm. were treated with extracorporeal shock wave lithotripsy in situ without auxiliary stenting.
RESULT:
Fifty five patients the mean age 40 years, 21 being males and 34 were females.
With renal pelvic stone, clearance of stone fragments was analyzed by x-ray KUB and ultrasound on first month and three months after treatment or until stone fragments were cleared. Twenty three 42 % were stone free three months after treatment while 32 patients 58% were having residual fragments. Treatment complications consisted of steinstrasse in seven 12.7%, pyelonephritis in two, four of steinstrasse cleared spontaneously, the other three steinstrasse were treated successfully with ESWL.
CONCLUSION:
Shock wave lithotripsy in situ for medium to large renal pelvic calculi (15 to 30 mm) is reasonable procedure, avoiding the morbidity of ureteral stent and additional cost.