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Ureteral calculi management: a therapeutic spectrum for an Algerian complex reality


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Ureteral Calculi Management: A Therapeutic Spectrum For an Algerian Complex Reality.
1. INTRODUCTION
After the first attempt in the 1980’s, the renaissance of ureteroscopy in Algeria was In 2008. Nowadays, the management of stone diseases that pose a serious public health problem in my country did not find their salvation mainly due to the limited availability of endourological specialized platforms.
2. AIMS AND OBJECTIVES
The aim of this work is to throw into relief the diversity of ureteric stones that a urologist might come across in his daily practice.
The study cases below are just few samples of that encountered reality.
3. METHODS  AND MATERIALS
Case One: Female aged 36 presenting with a 14 mm stone in the left pelvic ureter.
Case Two: Female aged 35 presenting with a 15 mm stone in the left pelvic ureter.
Case Three: Male aged 25 presenting with two ureteral stones: A 20 mm stone in the right lumber ureter and an 18 mm stone in the left pelvic ureter.
Case Four: Male aged 35 presenting with a 20 mm stone in the left kidney.
4. RESULTS
Case One: URS scheduled but spontaneous stone passage through MET after 3 weeks.
Case Two: Semi-rigid ureteroscopy and stone fragmentation with a ballistic lithotripter. Post OP JJ stent.
Case Three: Semi-rigid ureteroscopy and both stones were fragmented with LASER energy. Post OP JJ stent.
Case Four: The stone was embedded in the ureteropelvic junction. We performed a semi-rigid ureteroscopy with LASER energy and stone disintegration. Post OP JJ stent.
5. DISCUSSION
The Algerian urologist must opt for an adequate solution to relive his patients’ sufferings even if it requires going back to orthodox practice (open surgery). All the decisions taken in the treatment of our cases ended successfully.
The recommended treatment options for both proximal and distal ureteral stones removal is 10 mm maximum. However, the Algerian reality witnesses much larger stone sizes that necessitate very often the adoption of orthodox treatments namely MET
6. CONCLUSIONS
Though orthodox open surgery is still widely practiced in my country, ureteroscopy has offered us a confident alternative that is both less morbid and less frustrating for the urologist.