RENAL AND URETERIC CALCULI

Objectives: To assess the role of double J stent in management of renal andureteric calculi measuring 1.5 to 2.5 cm size prior to ESWL. Period: 1st January 2015 to 30thDecember 2015. Study Design: Retrospective study. Methods: We included 120 patientswhich were divided in two groups. In group A we took 40 patients in whom double J stentswere inserted before ESWL while in group B, 80 patients underwent ESWL without stenting. Weincluded patients of both sex having radio-opaque stones in kidney or proximal ureter measuring1.5cm to 2.5cm in size in adults (age > 18) years where stone fragmentation resulted afterESWL. The average stone size in both groups was comparable (p > 0.05). Patients with urinarytract infections, pregnancy, radiolucent stones, bleeding disorders, larger or small stones,anatomical abnormality, nonfunctioning kidney and where ESWL was not successful after thirdsession were excluded from study. The patients were randomized on basis of their choice foreither procedure and majority 80 patients (66 %) refused stenting before ESWL due to fearof invasive procedure and socioeconomic reasons. Patient’s pre-operative investigations likecomplete blood count, urea/creatinine, X-ray & ultrasound KUB and IVU were done. ESWL wasdone without anesthesia and after complete clearance of fragments stents were removed withinthree months. Results: Out of 120 patients 70 were male (58.33 %) and 50 were female (41.66%). In group A (with ureteric stenting) there was no ureteric obstruction noticed after ESWLand fragments clearance resulted with mild pain or discomfort in 12(10%) patients. There wasdelayed clearance of the fragments in patients but that had no impact on patient daily activities.While in group B (without ureteric stenting) 30 (37.5%) patients developed complications likesevere colicky pain for which they were hospitalized whereas remaining 50(62.5%) patientshad mild to moderate pain with stein-stresse appearance which was managed using oral andsystemic analgesics, increase oral fluids and reassurance to the patients. The time of stonefragments clearance was delayed in group A as compared to group B (p < 0.05). Conclusion:We conclude that double J stent should be passed prior to ESWL in cases of large renal andureteric calculi to avoid severe colicky pain.