Role of Extra Corporeal Shock Wave Lithotripsy (ESWL) in Management of Upper Ureteric Stone

Abstract

Introduction: Genitourinary stone disease is an important health problem due to an estimated prevalence in the general population of 2-3% and a lifetime recurrence rate of about 50%. There are multiple factors influencing the choice of the treatment, such as stone characteristics (expected stone composition, location and size) ^, symptoms (urinary tract infections, pain, and hematuria), patient factors (age, co-morbidities), particular contraindications or anatomic characteristics and availability of technical expertise. ESWL is an attractive option for management of renal and upper ureteric stone of less than 2 cm^. It is noninvasive in nature and associated with low complication rates.Methods: From September 2017 to December 2019, in the present study, in a series of 100 patients of upper ureteric stone who were managed by ESWL, All data were collected from medical records, which contained the clinical, laboratory evaluation and diagnostic imaging. Patients were underwent plain X-ray KUB at 2 weeks after each ESWL session to check for stone fragmentation. Clinically insignificant stones with size of stones less the 5 millimeter not causing symptoms and not associated with infection after ESWL were considered as success of treatment. Patients were followed at 2 weeks, 1 month, 2 month and 3 months. Patient had undergone X ray KUB and USG KUB during follow up.Results: The average age of patients in our study ranged from 2 - 70 years. stone size ranged from 5 to 20 mm; of which 36 (36 %) patients were of ≤10 mm stone size, 64 (64 %) patients were of 11-20 mm stone size. patients presented with multiple symptoms with most common presentation being flank pain in 83 patients. 20 (20%) patients had stone attenuation value less than 1000 HU, 50 (50%) had a stone attenuation value of 1000 HU – 1200 HU and 30 (30%) patient had stone attenuation between 1200 – 1500 HU minor complications like UTI (9), post procedural pain (51 %) mild Hematuria (26%) steinstrasse (5%) were seen which were managed accordingly. Out of 5 patients with steinstrasse following ESWL 3 patients managed by retrograde ureteroscopy and 2 patients were managed conservatively patients. In the present study, of 100 patients who were treated by ESWL, 92 (92%) patients were completely cleared of stone and were regarded as success of procedure at 3 months follow up whereas 8 (8 %) patients required auxiliary procedure URS and were regarded as failure ofESWL.Conclusions: Upper ureteric stone patients can be easily managed with eswl procedure in appropriately selected patients. ESWL is a non-invasive, cost effective, OPD procedure which can be safely performed without anesthesia even in the cases of upper ureteric stone having risk for invasive treatment with several advantages over other treatment modalities like RIRS and PCNL. Overall ESWL is associated with less significant complications, faster convalescence and greater patient acceptance.