Transurethral ureteroscopy for upper urinary tract stone in the Bahamas: A five-year experience, 1993 to 1998 - Poster abstract

OBJECTIVE: To review five years' experience of transurethral ureteroscopic stone removal as the primary treatment modality for all ureteral and select renal pelvic calculi in the Bahamas. DESIGN AND METHODS: The experience of a solo urologist in the Bahamas using transurethral ureteroscopic lithotripspy was reviewed retrospectively from 1993 to 1998. All patients presenting at either of two tertiary care facilities, with confirmed upper urinary tract calculi, were reviewed as potential candidates for endoscopic stone removal. If an initial conservative approach to allow patients to pass the stone spontaneously failed or was contra-indicated, all ureteral calculi<1cm sixe wer recommended for ureteroscopic stone removal. Stones were removed under direct endoscopic vision by basket stone extraction, electrohydraulic lithotripsy or ultrasonic lithotripsy as the primary technique or in combination. RESULTS: 110 cases of ureteral and intrarenal calculi required surgical intervention. The patient's ages ranged from 16 to 72 years with 69 males and 41 females. One hundred and nine (109) urinary tract stones were removed successfully by basket stone extraction, electrohydraulic or ultrasonic lithotripsy. Twenty of the upper ureteric stone (<1cm) were located within the kidney and had a transurethral procedure. Eighty-two percent (82 percent) of the cases were performed on an outpatient basis. There was one case of failed endoscopic surgery with subsequent ureterolithotomy. There were two major complications, a perforated ureter and ureteric avulsion. CONCLUSION: Transurethral ureteroscopic stone removal is a reliable, safe and a cost effective technique applicable for all ureteral stones and the appropriately sized renal stone in small resource-limited nation states whose urologists wish to provide state-of-the-art urinary tract stone surgery.(AU)

Extracorporeal shock wave lithotripsy without anaesthesia: a preliminary report of initial experience in Jamaica

Extracorporeal shock wave lithtripsy (ESWL) is the method of choice of treating most renal and ureteric stones. The electrohydraulic generated shock wave litholriptors, however, tend to produce pain at the shock wave entry site on the skin, and these treatments are usually administered under general anaesthsea. With the acquisition of an electrohydraulic ESWI machine (Econolith - 2000) by the UWI in August 1995, this method of treating stones is now available in Jamaica. Between September and November 1995 data was prospectively collected on all patients treated by ESWL. There were 20 patients in all undergoing 22 treatment sessions with 2 repeats. There were 11 females and 9 males with ages ranging from 24 to 73 years. A total of 20 renal stones and 2 ureteric were treated. Thirteen patients received Tenoxicam 40 mg IM 20 minutes before the procedure as the only form of analgesia. Of the thirteen patients, only one patient described the procedures as severely painful. Four patients described it as moderately painful and the remaining eight patients described the procedure as producing only mild pain or discomfort. There were no complications apart from bruising of the skin at the shock wave entry site of eight patients. There was fluoroscopic evidence of fragmentation of all stones during treatment. Patients receiving Tenoxicam 40 mg IM we able to be discharge a from hospital immediately after the treatment. In conclusion, from our preliminary experience thus far, electrohydraulic ESWL can be safely and humanely administered with good effect using 40 mg of Tenoxicam administered intra muscularly, thus obviating the need for general or regional anaesthesia with its attendant morbidity and mortality (AU)