N. Imdad Ali1 , Paresh Sankhe2 , Ravishankar T.H.S.3 , Jayaprakasha Gangadharaiah4
BACKGROUND Urinary stone disease is major health problem affecting 2 – 3 % population worldwide, and is more commonly seen in the working age group (30 - 60 years) of society. X-ray, USG, CT, and IVU are diagnostic modalities available to us. IVU is still being requested by clinicians as diagnostic tool for urolithiasis but we need to reassess the importance of this modality as it seldom makes a difference in the management decision and outcome. METHODS Medical records of 184 patients who underwent ureteroscopic pneumatic lithotripsy from 2016 to 2019 for lower ureteric calculus were reviewed retrospectively. All patients of lower ureteric calculus (n = 184) were included in study; of which 130 patients had undergone USG and x-ray as pre-operative imaging; 54 underwent CT / IVU in pre-operative imaging along with USG and Xray. Stone free rate, complication, requirement of repeat procedure, and post op fever were compared and analysed. RESULTS Results were analysed in view of the need of second look surgery, post op fever, complication, and Stone Free Rate (SFR). The majority of patients who underwent URSL were with lower ureteric calculus 184 (43.8 %), upper ureteric 145 (34.5 %), middle ureteric 70 (16.7 %) and multiple 21 (5 %). The mean stone size of lower ureteric calculus was 10.4 ± 3.8 mm. Stone free rate for with URSL for lower ureteric calculus was 88 %, upper ureteric calculus 60 %, middle ureteric calculus 68 %. Overall SFR was 69.5 %. SFR in patients with imaging group was 61 % whereas in patients who didn’t undergo imaging was 77.83 %; this difference is statistically significant with a p-value 0.0003 (< 0.05). The complication rates were group I 106 (50 %) and group II 95 (45.6 %) and the difference is not statistically significant. In patients with imaging study (CT and IVU) done in the pre-op period the average hospital stay is 3.89 ± 1.23 days. CONCLUSIONS IVU has a limited clinical role, and its use should be strictly limited to highly select cases and can be avoided in straight forward cases. Similarly, CT can also be avoided in straight forward cases of lower ureteric calculus as it doesn’t provide any added advantage in terms of decreasing intra-op complication and SFR.
