Objective: To compare the effectiveness of nifedipine and tamsulosin for expulsion lower ureteral stones with size ranging from 4mm-11mm. Study Design: A Randomized controlled trial. Methods: The study was held over a 2-year duration from January 2018 to December 2019 in the Urology department of Islam Medical College/ Teaching hospital Sialkot and Govt. Kot Khawaja Saeed Teaching Hospital Lahore. 72 total patients, 37 patients in each group, were selected for the study. The patients in A group were treated with alpha-1-blocker alone (tamsulosin), patients in B group were treated with calcium channel blockers (nifedipine 30-mg). Data on stone size, transit time, stone removal rate and control of pain were analyzed and collected. The mean ± SD of continuous variables was used to determine the percentage and frequency of categorical variables. The student’s t-test and Chi-square test were applied to compare numerical and categorical variables, correspondingly. Results: 72 total patients were involved and 36 patients in each group were analyzed after randomization. The patients mean age in A group was 36.40 ± 6.98 years, and in B group it was 38.01 ± 9.40 years correspondingly (p 0.76). The mean size of stone was 6.40 ± 1.82 mm in group A and in group B it was 6.51 ± 1.69 mm (p 0.80). Mean time of expulsion in A group was 8.40 ± 2.41 days and for group B; it was 6.71 ± 2.33 days (p <0.001). Patients receiving tamsulosin endured suggestively fewer attacks of pain related with patients receiving nifedipine treatment (p 0.017). Conclusion: The tamsulosin is safe treatment for appropriately sized lower ureteral stones as compared to nifedipine. The tamsulosin monotherapy have clear advantage over nifedipine but more detailed school studies are needed for efficacy and safety. Keywords: Tamsulosin, ureter, nifedipine.
Purpose: To present our experience with emergency ureteroscopic lithotripsy (URSL) on ureteral stones related with acute kidney injury (AKI). Place and Duration: In the Department of Urology for three years duration from January 2019 to January 2020. Material and methods: We retrospectively analysed 27 patients consisting of 54 ureteral units (UU) undergoing URSL. There were 9 females and 18 males with M: F of 2:1 The anuria cause was bilateral obstruction with calculi in 21 cases, and unilateral obstruction with calculi in 33 cases with contralateral nephrectomy. In the same session, bilateral ureteroscopy was performed for bilateral synchronous ureteral stones. The anuria duration ranged from 12hours to 3-days. After the procedure, all patients ureteral stent were systematically removed. The operation was accomplished 6-12 hours afterward hospitalization. After surgery; all individuals were followed for minimum one-month. Results: A total of 27 urgent URSL were performed in 9 (33.3%) females and 18 (66.7%) males with an average age of 51 (range 32 to 73). Percutaneous nephrostomy was performed in 2 (7.4%) patients and in 2 (9.5%) patients with bilateral stones, the ureteral units (UU), severely wedged distal hard stones. These patients were candidates for open surgery, ureterolithotomy, 6 to 8 weeks afterward the initial intervention (PCN+ URSL). The improvements in renal function as demonstrated by post-obstruction diuresis and serum creatinine were compared in the two groups of patients using the Fisher's exact test. In 20 (71.1%) patients, URSL proved to be an effective therapeutic approach for obstruction removal and stone removal. Repeat surgery was required in 3 (11.1%). In 3 (11.1%) patients, URSL caused significant damage to the mucosa with a guide wire in the area of the damaged ureteral calculus. Ureteral stenting was sufficient to treat this complication. Stone or fragment migration was observed in 5 (18.5%) patients, all of which were in the upper stone position, and this procedure was the main reason of failure. In the first 24 hours, mild macroscopic haematuria was detected which did not require treatment. Postoperatively, 6 (22.2%) patients had high fever. Body temperature reversed back to usual within four days after getting the high dose and intravenous injection of a third-generation cephalosporin antibiotic (ureteral stent culture for Escherichia coli and positive urine culture). Conclusion: Calculus anuria is a therapeutic emergency that necessitates timely analysis and decompression management. URSL is the appropriate technique for designated patients and can be accomplished securely and has a high achievement rate with insignificant incidence of morbidity. Key words: Ureteral stones, ureteroscopy; surgery; kidneys, anuria, abnormalities; outcome and treatment.
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