RESUMO
OBJECTIVES: To compare ureterovesical jet frequency in non-obstructed versus obstructed ureter secondary to ureteric stone using ultrasonography in patients presenting with ureteral stones. STUDY DESIGN: Cross-sectional prospective study. Place of study and duration: Urology Department, The Kidney Centre Post Graduate Training Institute from May 16 to November 15, 2019. METHODS: This study included 97 patients having presented in the emergency department with acute renal colic and were diagnosed as having ureteral stones on a non-contrast-enhanced computed tomography (NCCT). The ureteric jet frequency was measured by Doppler ultrasonography by our radiologist with the Hitachi Aloka F-37 ultrasound machine after they underwent CT. Patients were asked to drink 750-1000 ml of liquids 15-20 minutes before their ultrasonographic examination of both kidneys, ureters, and urinary bladder. The kidney size (length and width) and presence/absence of hydronephrosis were evaluated by grayscale ultrasound. Then, with the help of color Doppler ultrasonography, the frequency of the ureteric jet was recorded. RESULTS: The patient's mean age was 46.66 ± 3.21 years ranging from 37 to 56 years. There were 58 (59.8%) male and 39 (40.2%) female cases. The mean cumulative stone size was 9.77 ± 2.65 mm. According to stone location, 44 (45.4%) cases had upper ureteric, 24 (24.7%) cases had mid ureteric, and 29 (29.9%) cases had lower ureteric stone. The mean obstructive side jet frequency was 0.70/min ± 0.49, and the non-obstructive side jet frequency was 2.89/min ± 1.29 (P < 0.05). CONCLUSIONS: The mean obstructive side jet frequency was 0.70 ± 0.49/min, which, if we compare to the non-obstructed normal ureter, is significantly less. Hence, color Doppler ultrasonography can be helpful to patients who were previously diagnosed with ureteral stones on NCCT to see if their stone has passed. This can be a very cost-effective modality especially in resource-poor countries where repeat CT can be very expensive. The results from this study can also be used in a specific population (i.e., pregnancy) where the use of imaging modalities that involve ionizing radiation is prohibited.
RESUMO
OBJECTIVE: To ascertain the safety and efficacy of percutaneous nephrolithomy in patients with previous open renal surgery. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The Kidney Centre Postgraduate Training Institute, Karachi from January to December 2018. METHODOLOGY: Patients with previous open renal surgery underwent percutaneous nephrolithomy during study period (Group A). Equal number of percutaneous nephrolithomy patients without previous open surgery taken as controls (Group B). Safety was defined in terms of 'blood loss' as change in hemoglobin (HB) level and 'blood transfusion,' while efficacy was defined in terms of 'stone clearance' and were compared between both the groups. RESULTS: There were a total of 87 patients. Both groups had comparative gender ratio [p = 0.858]. Mean age [p = 0.132] and BMI [p = 0.879] of patients in both groups was not significantly different from each other. Both groups showed no statistically significant difference in terms of values of stone size [p = 0.186], stone laterality [p = 0.437] stone location [p = 0.949], preoperative Hb [p = 0.095], postoperative Hb [p = 0.423] and change in Hb (indicating blood loss, p = 0.398). Puncture levels were significantly different among both groups (supracostal puncture in 18 and 36 patients; infracostal puncture in 63 and 51 patients in groups A and B, respectively, p = 0.006), while operative time [p = 0.787], calyx punctured [p = 0.051], double puncture [p = 0.787], nephrostomy tube [p = 0.288] were statistically not different among groups. Similar number of patients demonstrated residual stones [p = 0.773], along with residual stone sizes [Group A (0.5; 0.5) and Group B (0.65; 0.38)] [p = 0.445]. Intra- and postoperative complications like blood transfusion [p = 0.700] and fever [p = 1.000] along with hospital stay [p = 0.614] were comparable among groups. CONCLUSION: Percutaneous nephrolithomy is safe and effective in previously operated kidneys despite the possibility of calyceal anatomy distortion and scarring. Key Words: Percutaneous nephrolithotomy, Open surgery, Kidney calculi.