Comparison of the Success of Extracorporeal Shock Wave Lithotripsy (Eswl) With and Without Dj Stenting in Proximal Ureteric Stone

Abstract

<jats:p>BACKGROUND &amp; OBJECTIVE: There is disagreement in the use of ureteral double-J stent before the extracorporeal shock wave lithotripsy (ESWL), although most of the urologists suggest using stent in shock wave lithotripsy technique for stones bigger than 20mm, for preventing the risk of developing steinstrasse. To compare the success of ESWL with and without DJ stenting in proximal ureteric stone. METHODOLOGY: A total of 60 patients form both genders, between 15 to 55 years of age, with a single proximal ureteric stone, were included. Patients with solitary functioning kidney, multiple stones, pregnancy, pyonephrosis and sepsis were excluded. In Group-A, ESWL without DJ stenting was completed while in Group-B, ESWL with DJ stent placement was done. In all patients, at least 4 sessions were done fortnightly. Patients were followed regularly and final success was noted after one month of completion of ESWL sessions.&#x0D; RESULTS: The mean age was 36.85 ± 8.61 years. From 60 patients, 29 (48.33%) were men and 231 (51.67%) were women.Mean body mass index (BMI) was 28.30±2.20 kg/m . The average size of the stone was 12.47 ± 2.57 mm. Success (according to stone removal) of Group-A (ESWL without DJS) was seen in 26 (86.67%) patients while in Group-B (ESWL with DJS) was seen in 16 (53.33%) patients with P-value of 0.005. &#x0D; CONCLUSION: This study concluded that success (in terms of stone clearance) of extracorporeal shock wave lithotripsy (ESWL) without DJ stenting is higher compared to with DJ stenting in upper ureteric stone.</jats:p>

Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients With Infected Ureterohydronephrosis Due to Ureteral Stones Following Double-J Catheter Insertion

“…Studies have shown that preprocedural stenting has no advantage in terms of stone fragmentation efficiency [2][3][4]. Some studies even show a decrease in the efficacy of ESWL, both after one [5][6][7] and after several sessions [8,9]. However, in most studies, the double-J catheter was inserted in patients with ureteral lithiasis without a clear indication for urinary diversion in these patients (obstruction with non-functioning kidneys, obstruction with superinfection), with the only purpose of increasing the efficacy of ESWL and possibly reducing morbidity by avoiding episodes of renal colic after the procedure [10][11][12].…”

“…However, in most studies, the double-J catheter was inserted in patients with ureteral lithiasis without a clear indication for urinary diversion in these patients (obstruction with non-functioning kidneys, obstruction with superinfection), with the only purpose of increasing the efficacy of ESWL and possibly reducing morbidity by avoiding episodes of renal colic after the procedure [10][11][12]. Other studies considered patients with double-J catheters inserted after infected ureterohydronephrosis or with non-functioning kidneys [5] as well as those in whom double-J catheters were placed to reduce morbidity and increase the effectiveness of ESWL [8], resulting in heterogeneous groups, which may ultimately lead to erroneous conclusions regarding the effectiveness and safety of ESWL in patients with double-J catheters. There are no studies so far that include a homogeneous group of patients in the case of pre-procedurally stented patients, such as patients who have had stents inserted due to infected ureterohydronephrosis.…”