RENAL AND URETERIC CALCULI

BENEFITS OF DOUBLE J STENTS IN MANAGEMENT WITH ESWL

Abstract

Objectives: To assess the role of double J stent in management of renal and
ureteric calculi measuring 1.5 to 2.5 cm size prior to ESWL. Period: 1st January 2015 to 30th
December 2015. Study Design: Retrospective study. Methods: We included 120 patients
which were divided in two groups. In group A we took 40 patients in whom double J stents
were inserted before ESWL while in group B, 80 patients underwent ESWL without stenting. We
included patients of both sex having radio-opaque stones in kidney or proximal ureter measuring
1.5cm to 2.5cm in size in adults (age > 18) years where stone fragmentation resulted after
ESWL. The average stone size in both groups was comparable (p > 0.05). Patients with urinary
tract infections, pregnancy, radiolucent stones, bleeding disorders, larger or small stones,
anatomical abnormality, nonfunctioning kidney and where ESWL was not successful after third
session were excluded from study. The patients were randomized on basis of their choice for
either procedure and majority 80 patients (66 %) refused stenting before ESWL due to fear
of invasive procedure and socioeconomic reasons. Patient’s pre-operative investigations like
complete blood count, urea/creatinine, X-ray & ultrasound KUB and IVU were done. ESWL was
done without anesthesia and after complete clearance of fragments stents were removed within
three months. Results: Out of 120 patients 70 were male (58.33 %) and 50 were female (41.66
%). In group A (with ureteric stenting) there was no ureteric obstruction noticed after ESWL
and fragments clearance resulted with mild pain or discomfort in 12(10%) patients. There was
delayed clearance of the fragments in patients but that had no impact on patient daily activities.
While in group B (without ureteric stenting) 30 (37.5%) patients developed complications like
severe colicky pain for which they were hospitalized whereas remaining 50(62.5%) patients
had mild to moderate pain with stein-stresse appearance which was managed using oral and
systemic analgesics, increase oral fluids and reassurance to the patients. The time of stone
fragments clearance was delayed in group A as compared to group B (p < 0.05). Conclusion:
We conclude that double J stent should be passed prior to ESWL in cases of large renal and
ureteric calculi to avoid severe colicky pain.