IAJPS 2020, 07 (09), 1112-1118 Shahnawaz et al ISSN 2349-7750

CODEN [USA]: IAJPBB ISSN : 2349-7750

INDO AMERICAN JOURNAL OF

PHARMACEUTICAL SCIENCES
SJIF Impact Factor: 7.187
http://doi.org/10.5281/zenodo.4065109

Available online at: http://www.iajps.com Research Article

THE EFFECTIVENESS OF URETEROSCOPY WITHOUT

FLUOROSCOPY FOR URETERAL AND RENAL STONES
1
Dr. Shahnawaz, 2Dr. Mahmood Ahmed, 3Dr. Babar Baig, 4Dr. Bilal Suria,
5
Dr. Muhammad Shahid Bhatti, 6Dr. Feroze Mahar
1
Associate Professor, Department of Urology, Shaheed Mohtarma Benazir Bhutto Medical College, Lyari
General Hospital, Khi., [email protected], 2MS (Surgery), Senior Registrar (Urology),
Shaheed Mohtarma Benazir Bhutto Medical College, Lyari General Hospital,
[email protected]., 3FCPS (Urology), Medical Officer, Urology, Lyari General Hospital,
[email protected], 4FCPS (Urology), Assistant Professor Urology Al-Tibri Medical College and
Hospital, Isra University, [email protected], 5FCPS (Urology) Assistant Professor Urology, Pir
Abdul Qadir Institute of Medical Sciences Gambat, [email protected], 6MBBS, Senior
Medical Officer Urology Lyari General Hospital Karachi, [email protected],
Article Received: July 2020 Accepted: August 2020 Published: September 2020
Abstract:
Objective:
We aim to study the effect of using ureteroscopy without fluoroscopy in children with ureteric and renal stones.
Study Design: Experimental study
Place and Duration of Study: Sindh Government Lyari General Hospital, Karachi from January 2015 till Dec 2018
Methodology:
This study was carried out on every patients diagnosed with renal and ureteral stones in department of Urology. We included all
patients with stone size less than 2 cm. Ureteroscopy was performed without fluoroscopy .We obtained the demographics, clinical
history and stone size details from the medical record database. However post-operative results and complication details were
collected with follow-up and information was analyzed using SPSS Version 20.
Results
In our data calculi was found in 44 Male (59% of total Patients) and 30 Females ( 41% of total patients) where the Mean age and
standard deviation was 15.29 ± 6.86.Resulting Complications without fluoroscopy were 12%.Overall 93% Patients were stone
free while CIRF was 7% without fluoroscopic operation.
Conclusion
This confirms that the exposure from radiation has harmful effects and that even without the use of fluoroscopy, ureteroscopy can
be performed successfully and stones can be removed.
Key words: Ureteroscopy, without fluoroscopy, ureteral and renal stones.
Corresponding author:
Dr. Shahnawaz, QR code
Associate Professor, Department of Urology,
Shaheed Mohtarma Benazir Bhutto Medical College,
Lyari General Hospital, Khi., [email protected].

Please cite this article in press Shahnawaz et al, The Effectiveness Of Ureteroscopy Without Fluoroscopy For Ureteral And Renal
Stones., Indo Am. J. P. Sci, 2020; 07(09).

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 IAJPS 2020, 07 (09), 1112-1118 Shahnawaz et al ISSN 2349-7750

INTRODUCTION: Dec 2018 .We included all patients with stone size less
Kidney stones can develop along the urinary tract than 2 cm.
anywhere from ureters to kidney. These stones are
formed due to the higher concentration of salt and Exclusion Criteria:
minerals in the urine. Usually these stones precipitate • Patients who showed ureter pelvic junction
out in urine however some need surgical treatment or obstruction ,
ultrasound or other similar techniques for flushing out • Patients with maltreated kidney , horseshoe
with the urine. kidney
• Patients with ectopic kidney and duplex
In case of larger stones, surgeries or other treatments system
are suggested by the physician. The maximum number • Patients with concomitant stones in ureter or
of stones found are made of Calcium, Struvite, Cystin kidney
and Uric acid. • Patients who underwent prior ipsilateral
urinary tract reconstructive procedures
Most kidney stones pass and don’t necessarily need • Patients with a history of ipsilateral ureteral
treatment however in case of stone sizes greater than 2 stricture
cm, treatment become necessary and one of the most
• Patients who received prior radiotherapy in
prevalent methods involve the use of fluoroscopy
abdomen or pelvis
however as people are getting more and more aware
• Patients who had previously undergone stone
with the harmful effects of radiation hazards linked
surgery.
with the medical imaging, the need for newer and
better methods has become significant. [1,2] Although
Operative Details:
every method has its merits and related demerits yet
All the patients suffering from ureteral calculi
choosing the ideal alternative is quite challenging.
prospectively underwent ureteroscopic removal.
Using ureteroscopy Double-J stent are placed and after
According to the USA Food and Drug Administration,
the treatment is over, X-ray of the kidney and ureter
physicians are suggested to lessen their exposure to
are checked for documenting stone-clearance.
radiations caused by fluoroscopic procedures. [3]
We obtained the demographics, clinical history and
Stone diseases have been stated to rise up to 77% in
stone size details from the medical record database.
asymptomatic intracranial stones and around 26% of
However post-operative results and complication
them will need to undergo surgery. [4,5]
details were collected after one month follow-up of
only patient who gave consent and we classified
Usually the success rate recorded of Ureteroscopy is
results into two categories ; Stone free and clinically
good around 81-94% according to one study and
insignificant residual fragments (CIRF (≤4 mm).We
stone-clearance is also achieved in maximum
conducted our analysis and data analysis using SPSS
procedures performed without the need of repeat
Version 20.
procedures and with only minimum amount of
complications recorded. [6,7]
RESULTS:
In our study group, a mean age of 15.29 ± 6.86 years
METHODOLOGY:
is recorded with a male to female ratio of 59% to 41%
We conducted this study on renal a ureteral stones in
where the maximum age documented was 35yr while
department of Urology, Sindh Government Lyari
minimum was 6 year old. (Table-I).
General Hospital, and Karachi from January 2015 till

Variable Total Population

Demographics

Mean Age ± SD 15.29 ± 6.86

Maximum 35 year
Minimum 6 year
Male to Female 59% : 41%
Table-I Demographics of Patients

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35 33

30

25 23

20

15
11
10
4 3
5

0
under 11 12 TO 14 15 TO 17 17 to 25 25 to 35

Figure-1 Age Range in ureteral and Renal Calculi Patients

We observed the age bracket of under 11have the highest number of calculi Patients i.e. 33 out of our total
population of 74 while 17-25 being at 23 tallies and 12-14 and 15-17 being the least with only 11 and 4 people
falling in this age while 25 to 35 had only 3 patients . (Figure-1)

Figure-2 Mean Operation and Hospital time in ureteral and Renal Calculi Patients

The mean operation time observed was 59.03 ±19.44 mins in Calculi Patients while the mean hospital stay was 1.59
± 0.826 days. (Figure-2)

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Stone Size and Location Gender wise

2.500

2.000
1.225 1.096
1.500 1.050

1.000
0.876 0.985 1.033
0.500

0.000
Left Middle Right

female male

Figure-3-Details of Stone size and Location Gender wise

The mean stone size recorded in Females is 0.876 cm on left side while Male has mean stone size of 1.05 cm and
mean stone size on middle location was 1.225 in Males and 0.985 in Females however in Right side relatively
Females had very similar size of Stones as Males; 1.056 cm vs 1.096 cm. Overall the mean stone size is 1.066 cm.
(Figure-3).We also observed both genders showed maximum number of stones in the middle region.

6 urinary infection
1
5 Migration upward
/downward
4 2 Haematuria

3
Encrustation
1 1
2
dysuria
1 1
1 0 0
1 1
Difficulty Storing
0 0

female male

Figure-4-Post-Operative Complications Gender wise

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Patients suffered from stone-migration either upward or downwards around 5% in males or 3% in females .Other
complications observed included hematuria, encrustation, dysuria etc. However overall complication rate was higher
in males i.e. 14% vs 10% in females. (Figure-5)

Complication Rate
16% 14%
14%
12% 10%
10%
8%
6%
4%
2%
0%
Female Male

Figure-5 Gender-Wise Post-Operative Complication Rate

Patients showed a stone-free rate of 93%with clinically insignificant residual fragments in only 7% cases ( Figure-
6).

weightage

CIRF 7%

Stone-Free 93%

0% 20% 40% 60% 80% 100%

Figure-6 Stone free and CIRF Rate

DISCUSSION: moved down in the ureters. Usually males suffer from

Stones is kidney have been identified to cause acute this pain in their groin area and can sometimes lead to
pain however it can be caused due to medications or severe situations.
poor nutrient in diet or less water intake or excessive
calcium intake .Although they can flush through the Fluoroscopy is used in numerous investigations
urines depending on their size unless the stone has however its most frequent use is in diagnosis,

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treatment and retrievals of stones in kidney and ureter

yet due to its post-operative complications many CONCLUSION:
surgeons prefer using Double J stent or Thus if we compared the results in female and male
ultrasonography and other flexible techniques. patients ,we see similar findings with regards to mean
age and operation time and hospital stays however the
In our investigations there was no notable difference complication rate and resulting stone-free rate show
in mean age of patients and standard deviation in slight variation. Overall the method is safe due to the
females and males; 15.15 years and 15.38 respectively resulting low complication rate. Although
while Yuruk et al studied the mean age to be 10.9 ureteroscopy without fluoroscopy is suggested and
years. 12.In a local study by Mohey Ahmed and used by most surgeons due to radiation exposure, your
Colleagues the mean age observed in the group findings validate it and thus it can be used for most
without fluoroscopy was 29.5 +/- 14.6 years. [14] procedure.

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