Category: Clinical Stones: Ureteroscopy
Introduction & Objective : Ureteroscopic lithotripsy is considered as the first line treatment for ureteral stones that fail to respond to medical expulsive therapy or SWL.During ureteroscopic lithotripsy, possibility of stone retropulsion or upward migration limit the success rate to a minor extent,to guard against this problem, many devices were used as a solution to this problem.We used the basketed stone entrapment on purpose to avoid proximal stone migration during ureteroscopic pneumatic lithotripsy . Our aim is to evaluate the efficacy and safety of a novel benefit of the dormia basket by using it on purpose to guard against proximal stone migration.
Our retrospective study was conducted between January 2015 and March 2017 at Minia university hospital. 282 patients who underwent ureteroscopic removal of ureteric stones were included in the study . Patients were categorized into two groups; group 1 (162 patients) in whom basketed stone entrapment was used to prevent stone migration, and group 2 (120patients) served as control group in whom no additional anti-retropulsion devices were used . Retropulsion was considered when stone ≥5 mm migrates to the kidney.
This study included 282 patients. The patients were divided into two groups, group 1 included 162 patients assigned as treatment group , and group 2 included 120 patients assigned as control group. The mean stone burden was 13.1±4.2 ,ranging from 6.5-16 mm, while it was 13.8±3.5 in control group with no statistically significant difference (P 0.7). lower ureteric stones were 64.2% and 63.3%, while upper ureteric stones were 13.6 % and 13.3 %.respectively. Calcium oxalate stones were the predominant stone composition (52.5%). We recorded a significant difference regarding the operative time ,with mean operative time 58.3±12.4 and 50.9±11.2 in both groups respectively. Retropulsion rate (fragments of ≥5 mm) showed a significant difference among both groups recording 1.2 % (2 patients) in group 1,those patients were underwent SWL compared to 30 cases (25%) in the control group ,in whom SWL was done for 21 patients, and 9 patients referred to flexible ureteroscopy. Minor mucosal lacerations was recorded in 16.6 % and 14.1% in group 1 and group 2 respectively. In group 1 we recorded 4 cases in which inadvertently, wires of the dormia were torn without any hazards to the ureter.
Conclusions : We concluded that using on purpose basketed stone entrapment uring ureteroscopic pneumatic lithotripsy is feasible, efficient and reproducible tool in preventing proximal stone migration with minimal morbidity , and with minimal or no extra cost.
Ehab Tawfiek– Minia, Al Minya, Egypt
Tarek Fathelbab– Ass.Professor, Faculty of Medicine,Minia University, El Minia, Al Minya, Egypt
Amr Abdelhamid– Minia, Al Minya, Egypt
Ehab Galal– Assistant professor of urology , Minia university, Minia, Al Minya, Egypt
Ahmad Ali– Minia, Al Minya, Egypt
Ahmad Anwar– Minia, Al Minya, Egypt
Minia, Al Minya, Egypt
Ehab Rifat Tawfiek
MD in Urology
Endourology Fellowship at Thomas Jefferson University
(USA) with professor Demetrius Bagley
Chairman Urology Department Minia University
Director of Minia University Urology and Nephrology Hospital
X President of Endourology section Egyptian Urological Association
Faculty of Medicine,Minia University
El Minia, Al Minya, Egypt
Assistant professor of urology
Minia, Al Minya, Egypt
Dr Ehab Galal, assistant professor of urology,Minia University,Egypt
I have been graduated in 1995 from Minia university and worked as resident of urology then assistant lecture
In 2008 i graduated for M.D. urology then work as assistant professor since 2016 till now
Also i am worked as a consultant of urology,Aljazerra hospital,KSA
I am interested in endourology and have many reserches at this point