Keywords : ureteroscopy


Evaluation of Holmium YAG laser Lithotripsy in Ad-Diwaniyah Teaching Hospital

Montadhar Hameed Nima; Ali Hamdan Fahad; Mohammed Ali Gadhban

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 344-349

ABSTRACT:
BACKGROUND:
In this study we evaluate the efficacy and safety of ho:yag laser lithotripsy via rigid ureteroscopy as primary treatment modality of ureteric ston in our institute stones parameters,stone free rates and complications rates were evaluated
OBJECTIVE:
To evaluate holmium YAG (yttrium aluminum garnet) laser lithotripsy via semi rigid ureteroscope in management of ureteric calculi in Ad-Diwaniyah teaching hospital.
METHODS:
From October 2013 to October 2014, 100 patients with ureteric calculi were included in this study. Calculi were approached with 9.5 Fr. Semi rigid ureteroscope and fragmented with holmium YAG laser system (Stone light AMS).
The following parameters were assessed: success, failure, and complications rates in addition to patient’s age, sex, stone size and site. Cases of failure of introduction of the ureteroscope or those with small stones retrieved by grasper only were excluded from the study. Termination of the procedures because of perforation or retropulsion were considered as failure.
RESULTS:
Sixty five males and 35 females were included with a mean age of (39±3) years (range 20-60). Fifty eight patients (58%) had lower ureteric stone, 25 patients (25%) had mid ureteric stone and 17 patients (17%) had upper ureteric stone. Mean stone size was 10.61 mm (range 7-20mm).
Overall success rate was 96% which was more for the lower than upper ureteric stone. Failure occurred in 4 patients (4%), 2 of them due to retropulsion and the other 2 patients due to ureteric perforation.
Apart from ureteric perforation and retropulsion, complications were minor and were amenable to conservative treatment.
CONCLUSION:
Holmium YAG laser lithotripsy is a minimally invasive, highly effective safe method for treatment of ureteral calculi.

A New Assessment Tool to Predict Stone Free Rates in Ureteroscopic Laser Lithotripsy

Ayad Aziz Al Naymi; Saad Dakhil F.Daraji

Iraqi Postgraduate Medical Journal, 2016, Volume 15, Issue 3, Pages 316-320

ABSTRACT:
BACKGROUND:
Holmium: YAG laser lithotripsy shows a high successful rate in fragmentation of ureteric stones , The S.T.O.N.E. Score is a novel assessment tool to predict stone free rate (SFR )in patients undergoing Ureteroscopic Lithotripsy( URS).
OBJECTIVE:
To develop a user friendly system (S.T.O.N.E. Score) to quantify and describe stone characteristics provided by computed axial tomography scan to predict ureteroscopic lithotripsy outcomes and to evaluate the characteristics that are thought to affect stone free rate.
PATIENTS AND METHODS:
The S.T.O.N.E. score consists of 5 stone characteristics: (S)ize, (T)opography (location of stone), (O)bstruction, (N)umber of stones present, and (E)valuation of Hounsfield Units. Each component is scored on a 1-3 point scale. The S.T.O.N.E. Score was applied to 50 ureteroscopic procedures performed , patients with anatomical abnormalities such as duplicated ureters, horseshoe kidney, ureteral strictures and renal failure were excluded from the study, postoperatively patient were evaluated by KUB,U/S and CT scan to assess stone free status.
RESULTS:
The mean patient age was( 37.3± 12.5 )year. 58% were male patients and 42% were female patients. mean stone size was13±3.9. Stones locations: 20(40%)stones were located in the lower ureter,13(26%) in the mid ureter ,17(34%) in the upper ureter. Mean operative time was 26.9±18.3 minutes. The overall SFR was 84%. Results of stone size on percent of stone destruction was very significant (p-value=0.001). Also the results of stone location on percent of stone destruction was very significant (p-value =0.002). whereas hydronephrosis, stone number, stone HU unite were not significant(p-value 0.8, 0.54, 0.61. respectively ). Results of stone score with SFR was significant (p-value 0.003).
CONCLUSION:
The S.T.O.N.E. Score is a new assessment tool to predict SFR in patients who require URS for the surgical therapy of ureteral disease. The features of S.T.O.N.E. are relevant in predicting SFR with URS. Stone size, location were statistically significant factors in multivariate analysis. The S.T.O.N.E. Score establishes the framework for future analysis of the treatment of urolithiasis .