الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
In this series we report our experience in the management of ureteric stones causing obstructive anuria with emergency ureteroscopy. The outcomes, complications, and supposed advantages of this approach were critically analyzed.
A prospective study was conducted of all procedures performed for patients attending at our department with calcular obstructive anuria due to ureteric stones, and were managed by emergent semi-rigid ureteroscopy with pneumatic lithotripter to remove the ureteral stones without initial drainage.
Fifty seven patients underwent ureteroscopy for ureteric calculi were included in this study. URS was performed under spinal anesthesia with a semi-rigid ureteroscope and the aid of fluoroscopy. Ureteral dilation was carried out by ureteroscope. Stones were disintegrated using pneumatic lithotripter and were extracted by dormia basket in 48 (84.2%) patients and grasper in 9 (15.8%) patients.
The overall stone free rate was 91% (52 of 57 procedures). The procedure was successful for distal ureteric stones in 91.7% and 88% for mid ureteric stones. All of the cases were stented after ureteroscopy except 2 ureteral units due to the inability to negotiate the ureteral orifice from the start. One managed by nephrostomy tube in the only function kidney then underwent delayed URS and became stone free. The other one was underwent successful Lt URS with double j while Rt side was failed to negotiate its orifice and elective successful URS was done after 1 month. We had significant mucosal laceration at the site of impacted ureteral stones in 3 (5.3%) patients and managed by double j at the end of procedure. Stone and fragment migration was seen at 3 (5.3%) patients and migrated stones were subjected to SWL 14 days after URSL and after normalization of serum creat. The hospital stay was ranged from 24hs to 72hs with a mean of 52.63± 10.58 hours.
Conclusion
Calculus anuria is a urological emergency that requires rapid diagnosis and prompt treatment for the purpose of decompression and preservation of renal parenchyma.
Emergent ureteroscopy with pneumatic lithotripsy appears to be a safe and successful treatment modality for obstructive ureteric stones, especially distal ones with minimal morbidity.