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Abstract
Introduction
ESWL has been demonstrated to be an effective, noninvasive, convenient and easy way in treatment of ureteric stones at all levels. However, ESWL in impacted ureteral stones is a challenge as they are considered to respond poorly to ESWL than stones lying in the renal pelvis. It was recommended to fix pre-ESWL ureteric stent for better fragmentation of the stone and to relieve the obstruction. However, insertion of a JJ stent is a more invasive procedure requiring anesthesia and it is associated with some discomfort and morbidity.
Aim of the work
Our prospective study was conducted between June 2007 and June 2008 to assess the efficacy of ESWL in management of impacted upper ureteral stones 2cm or less and to verify whether pre-ESWL ureteric stenting would affect the results.
Patients and Methods
Sixty patients with solitary, radio-opaque impacted upper ureteral stones 2cm or less were divided into 2 equal groups, stented group(Group 1) with a JJ stent fixed pre-ESWL and nonstented group (Group 2) who were treated by in situ ESWL. All patients were treated by ESWL using Dornier Do Li S lithotripter. Pretreatment KUB and IVP and post treatment KUB were used to follow up the clearance of fragments.
Results
At 3 months, overall stone free rate was 88.3%. There was no significant statistical difference in stone free rate between the 2 groups being 90% and 86.7% in the 2 groups respectively (p=0.688). One session was required in 28.3% of patients, while, multiple sessions were required in 71.7% of patients. There was no significant statistical difference in re-treatment rate, loin pain or fever in the 2 groups. However, patients in the stented group significantly complained of side effects attributable to the stent including: dysuria, urgency, frequency of micturition, suprapubic pain, haematuria, pyuria and positive urine culture.
Conclusion
ESWL is an effective and reasonable initial therapy in management of impacted upper ureteral stones 2cm or less. Pre-ESWL ureteric stenting provides no additional benefit over in situ ESWL in management of impacted upper ureteral stones 2cm or less. Moreover, ureteral stents are associated with significant patient’s discomfort and morbidities.