A three- Years Single Centre Experience In Ureteroscopy-Laser
Dr. Hichem KOUICEM
The motive behind undertaking this study was to scrutinize the safety profiles of the integration of Ureteroscopy Holmium Laser Lithotripsy to clear ureteral stones found in different localisations along the ureter. The profiles were considered to be a safer and minimally invasive procedure that could help urologists decide on the most appropriate treatment modality as well as streamlining the most suitable care for a given stone patient.
METHODS AND MATERIALS
We retrospectively evaluated endoscopic outcomes compiled from the records of 51 patients diagnosed with ureteral stones to determine the salvation role of ureteroscopy.
From November 2013 to November 2015, the 51 patients were treated following a retrograde endoscopic procedure using a small-caliber Ureteroscope and a holmium laser lithotripter of which 32 (62,75%) were men and 19 (37,25%) women, whose mean age was 44 years with ureter stones at different localisations as imaged by the CT scan.It is worth mentioning that the 51 patients did not undergo any pre-operatory stenting . Although the mean maximal stone size was 3.3 cm.
23 ureteral calculi were found in the right ureter, 26 in the left ureter and 02 were bilateral. The mean size of the stones was 16 mm and they were located at the distal ureter in 14 cases and proximal in the 37 remaining patients. 18 cases were impacted calculi. All cases were operated with a Semi Rigid Ureteroscope Holmium Laser.
The 51 patients were successfully treated after a single endoscopic procedure. The mean operative time was 53 minutes. No major intraoperative complications were encountered. The minor complications included only self-limited postoperative fever and hematuria. No postoperative ureteral stricture transpired. 16 (31,37%) patients were stented, ureteral catheters were left for drainage for 14 (27,45%) patients and 21(41,17%) patients were left unstented. Both radiography and ultrasonography were performed at a follow-up visit in 4 weeks: No patient had evidence of residual stones
The implementation of ureteroscopy as a first line therapy could lead to a noteworthy upsurge of the success rates and also would diminish serious complications that might hamper the clearing procedure. The obtained results were a significant indication that would discourage prescribing open surgery which is still adopted especially in the case impacted ureteral stones. Our data indicated that ureteroscopy is a safer and more effective modality in the treatment of stones at any localisation along the urinary tract