Research code: 99000902
Ethics code: IR.BMSU.BAQ.REC.1401.080
Clinical trials code: F2R12P87
, hmokhtari@aut.ac.ir
Abstract: (554 Views)
Background: Kidney stone disease is a common problem that can be related to changes in soluble compounds in urine such as high calcium in urine. Patients with kidney stones go to the emergency room with common symptoms such as flank pain and hematuria but flank pain and hematuria are not always symptom of kidney stones (2). Diagnosing the composition of urinary stones before treatment helps in managing this disease. The common side effects of kidney stones are severe and sudden pain in the sides due to the stone moving in the ureter and blocking its path. It may also cause infection and damage to the kidney, which causes acute tubular necrosis through the lack of oxygen in the damaged cells, and if the patient is not treated in time, the patient will go to acute kidney failure (4). Kidney stones are the causes of the renal side of acute kidney failure, which causes a decrease in urine flow through obstruction (5). CT scan is an important standard for radiographic evaluation of kidney stones. CT scan is very sensitive for diagnosing kidney stones and shows valuable information such as stone size, stone composition, location and amount of stone (7). Extracorporeal shock wave lithotripsy (ESWL) entered medical science in the 1980s, and since then has become one of the main treatment cases for patients with kidney and ureteral stones. However, due to the advancement of endocrinology and minimally invasive surgeries with high success rates, its use has decreased (8). The use of ESWL for stones larger than 15 mm is limited due to the low success rate and the need for multiple sessions to optimize the results (9). The use of double J stents is recommended for transportation and stone breaking, especially for stones of 5-15 mm in calyces and proximal ureter, but this method still debated among urologists in terms of its usefulness and complications. This study was conducted on comparing the rate of complications and stone removal following extracorporeal lithotripsy in patients who were treated with and without double J stent in Baqiyatullah-ul-Azam Hospital of Tehran between 1400 and 1402
Methods: This study is a retrospective cohort study in patients with kidney and ureteral stones with a size of 5-15 mm, who underwent extracorporeal lithotripsy in two cases, presence or absence of double J in Baqiyatullah Al-Azam Hospital in the years 1400 to 1402. In order to insert the ureteral stent, the patient was taken to the operating room and after anesthesia, he was placed in a lithotomy position. Using a ureteroscope, it enters the bladder and a ureteral stent is inserted retrogradely. In some cases, a guide wire is used to enter the ureter and a stent is placed. 120 patients (73 men and 47 women) were included in the study by census. The inclusion criteria for the study include all patients with lower, middle, upper calyce and proximal ureteral stones with a size of 5-15 mm, who need extracorporeal lithotripsy treatment. The exclusion criteria are the presence of ureteral aneurysm or renal artery aneurysm in the patient, pregnancy, uncontrolled urinary infection, uncorrected coagulation disorders, stenosis of the junction of the ureter with the pelvis, and severe obesity. In this study, all patients had an ultrasound or CT scan confirming ureteral stones or calyces. In the first group (60 patients, 29 men and 31 women), there were patients who were first subjected to inserting a double J stent and then sent for extracorporeal lithotripsy. َA simple X-ray or ultrasound or CT scan was taken from them again to determine the amount of remaining stone and its removal, and then they were subjected to the removal of double J. The second group (60 patients, 44 men and 16 women) was first sent for extracorporeal lithotripsy. A simple X-ray or ultrasound or CT scan was taken from them, and based on that, they were operated upon in case of stones. All patients had one session of extracorporeal lithotripsy, except for one patient who had a 9mm proximal ureteral stone, which was performed once before and once after double J stent. There were no cases of single kidney and kidney failure in any of the patients and all patients were followed up 3 to 4 weeks after extracorporeal stone crushing. Finally, the data of the two groups were examined and compared an analyzed using SPSS statistical software (Phi and Cramer's V method), and P=0.05 was considered as a significant level.
Results: Most of the examined patients are in the age range of 41 to 60 years. The average age of the group1 with double J was 47.45±6.78 years and in the group2 without double J was 44.43±8.91 years. For the group1 the skewness ratio (-0.87) and the kurtosis ratio (-1.56) are in the range [-2,2] and the age distribution can be considered normal. For the group2 the skewness ratio is 2.16 and kurtosis ratio is 4.13, and the distribution of the age is not normal. The rate of stone removal in the group1 is 48.3%, which is almost the same as the group2 (50%). In both groups, the most amount of stone removal is related to the 5-10 mm stone size. The relationship between the use of double J and stone removal (P=0.855) is not significant. The complication of hematuria in the group1 is 83.3%, which is more than the group2 (61.7%). In both groups, the most amount of hematuria is related to the 5-10 mm stone size. The relationship between the use of double J and hematuria (P=0.008) is significant. The rate of both complications of nausea and vomiting in the group1 is 1.7%, which is less than the group2 (15%). In both groups, the most amount of nausea and vomiting is related to the 10-15 mm stone size. The relationship between the use of double J and nausea (P=0.008) and vomiting (P=0.008) is significant. The complication of pain in the group1 is 36.7%, which is almost the same as the group2 (38.3%). The most amount of pain in the group1 is related to the 5-10 mm stone size and in the group2 it is related to the 10-15 mm stone size. The relationship between the use of double J and pain (P=0.850) is not significant. The fever complications were observed only in two cases of stone size 10-15 mm (one case in the group1, one case in the group2). The relationship between the use of double J and fever (P=1.000) is not significant. The complication of urinary infection was observed in only one case of stone size 10-15 mm in the group2. The relationship between the use of double J and urinary infection (P=0.315) is not significant. Urinary obstruction was not observed in any case.
Conclusion: The most important results obtained in the present study is that the rate of stone removal after extracorporeal lithotripsy in calyceal and ureteral stones with and without double J is almost the same and there is no significant relationship (P=0.855) and extracorporeal lithotripsy without double J clears the proximal ureter of stones, and there is no need for double J to remove stones. There is a significant relationship between the use of double J and the complications of hematuria (P=0.008), nausea (P=0.008) and vomiting (P=0.008). The relationship between the use of double J and complications of pain (P=0.850), fever (P=1.000), urinary infection (P=0.315) and urinary obstruction is not significant.
Methods: This study is a retrospective cohort study in patients with kidney and ureteral stones with a size of 5-15 mm, who underwent extracorporeal lithotripsy in two cases, presence or absence of double J in Baqiyatullah Al-Azam Hospital in the years 1400 to 1402. In order to insert the ureteral stent, the patient was taken to the operating room and after anesthesia, he was placed in a lithotomy position. Using a ureteroscope, it enters the bladder and a ureteral stent is inserted retrogradely. In some cases, a guide wire is used to enter the ureter and a stent is placed. 120 patients (73 men and 47 women) were included in the study by census. The inclusion criteria for the study include all patients with lower, middle, upper calyce and proximal ureteral stones with a size of 5-15 mm, who need extracorporeal lithotripsy treatment. The exclusion criteria are the presence of ureteral aneurysm or renal artery aneurysm in the patient, pregnancy, uncontrolled urinary infection, uncorrected coagulation disorders, stenosis of the junction of the ureter with the pelvis, and severe obesity. In this study, all patients had an ultrasound or CT scan confirming ureteral stones or calyces. In the first group (60 patients, 29 men and 31 women), there were patients who were first subjected to inserting a double J stent and then sent for extracorporeal lithotripsy. َA simple X-ray or ultrasound or CT scan was taken from them again to determine the amount of remaining stone and its removal, and then they were subjected to the removal of double J. The second group (60 patients, 44 men and 16 women) was first sent for extracorporeal lithotripsy. A simple X-ray or ultrasound or CT scan was taken from them, and based on that, they were operated upon in case of stones. All patients had one session of extracorporeal lithotripsy, except for one patient who had a 9mm proximal ureteral stone, which was performed once before and once after double J stent. There were no cases of single kidney and kidney failure in any of the patients and all patients were followed up 3 to 4 weeks after extracorporeal stone crushing. Finally, the data of the two groups were examined and compared an analyzed using SPSS statistical software (Phi and Cramer's V method), and P=0.05 was considered as a significant level.
Results: Most of the examined patients are in the age range of 41 to 60 years. The average age of the group1 with double J was 47.45±6.78 years and in the group2 without double J was 44.43±8.91 years. For the group1 the skewness ratio (-0.87) and the kurtosis ratio (-1.56) are in the range [-2,2] and the age distribution can be considered normal. For the group2 the skewness ratio is 2.16 and kurtosis ratio is 4.13, and the distribution of the age is not normal. The rate of stone removal in the group1 is 48.3%, which is almost the same as the group2 (50%). In both groups, the most amount of stone removal is related to the 5-10 mm stone size. The relationship between the use of double J and stone removal (P=0.855) is not significant. The complication of hematuria in the group1 is 83.3%, which is more than the group2 (61.7%). In both groups, the most amount of hematuria is related to the 5-10 mm stone size. The relationship between the use of double J and hematuria (P=0.008) is significant. The rate of both complications of nausea and vomiting in the group1 is 1.7%, which is less than the group2 (15%). In both groups, the most amount of nausea and vomiting is related to the 10-15 mm stone size. The relationship between the use of double J and nausea (P=0.008) and vomiting (P=0.008) is significant. The complication of pain in the group1 is 36.7%, which is almost the same as the group2 (38.3%). The most amount of pain in the group1 is related to the 5-10 mm stone size and in the group2 it is related to the 10-15 mm stone size. The relationship between the use of double J and pain (P=0.850) is not significant. The fever complications were observed only in two cases of stone size 10-15 mm (one case in the group1, one case in the group2). The relationship between the use of double J and fever (P=1.000) is not significant. The complication of urinary infection was observed in only one case of stone size 10-15 mm in the group2. The relationship between the use of double J and urinary infection (P=0.315) is not significant. Urinary obstruction was not observed in any case.
Conclusion: The most important results obtained in the present study is that the rate of stone removal after extracorporeal lithotripsy in calyceal and ureteral stones with and without double J is almost the same and there is no significant relationship (P=0.855) and extracorporeal lithotripsy without double J clears the proximal ureter of stones, and there is no need for double J to remove stones. There is a significant relationship between the use of double J and the complications of hematuria (P=0.008), nausea (P=0.008) and vomiting (P=0.008). The relationship between the use of double J and complications of pain (P=0.850), fever (P=1.000), urinary infection (P=0.315) and urinary obstruction is not significant.
Keywords: double J stent, extracorporeal shock wave lithotripsy, renal calyce stone, proximal ureteral stone
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