PRE-STENTING IN A DIFFICULT URETER: WHAT IS THE INCIDENCE?

Objective: To estimate the occurrence of “difficult ureter” where stenting was performed as a preliminary step for passive ureteric dilatation before second ureterorenoscopy and to create awareness of the incidence of this abnormality in our setting. Study Design: Cross sectional prospective case...

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Autores principales:	Haroon Sabir Khan, Malik Nadeem Azam Khan, Faisal Hanif
Formato:	article
Lenguaje:	EN
Publicado:	Army Medical College Rawalpindi 2018
Materias:	difficult pre-stenting ureter Medicine R Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/8430669c63d04c18bdf25553cad8c85c
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spelling	oai:doaj.org-article:8430669c63d04c18bdf25553cad8c85c2021-12-03T02:49:44ZPRE-STENTING IN A DIFFICULT URETER: WHAT IS THE INCIDENCE?0030-96482411-8842https://doaj.org/article/8430669c63d04c18bdf25553cad8c85c2018-10-01T00:00:00Zhttps://www.pafmj.org/index.php/PAFMJ/article/view/2334/2025https://doaj.org/toc/0030-9648https://doaj.org/toc/2411-8842Objective: To estimate the occurrence of “difficult ureter” where stenting was performed as a preliminary step for passive ureteric dilatation before second ureterorenoscopy and to create awareness of the incidence of this abnormality in our setting. Study Design: Cross sectional prospective case review study. Place and Duration of Study: Study was conducted in Urology department of PNS Shifa Karachi, from Jul 2017 to Mar 2018. Material and Methods: All patients who presented to our institute for ureteric calculi with normal creatinine and no urosepsis were included in the study. The procedure was carried out either in spinal anesthesia or general anesthesia using laryngeal mask. The outcome data of ureterorenoscopyin all patients including those patients who required pre-stenting for difficult ureters were documented. Results: Ureterorenoscopy was performed in 164 patients (mean age 34 years, range 14 to 70 years) for treatment of ureteric calculi. Among these 29 patients (17.7%) had upper, 52 patients (31.7%) had middle and 83 patients (51%) had lower ureteric calculi. Stone clearance was achieved in 135 (82%) of patients. In 16 (9.7%) patients the stone had to be pushed back for Extracorporeal Shock Wave Lithotripsy later. “Difficult ureters” were encountered in 13 patients (7.9%) in which Double J stents were placed under fluoroscopy and staged successful ureterorenoscopy were performed after 2 to 3 weeks without any complication. Conclusion: There was a 7.9% (about 8%) incidence of encountering “difficult ureter” while performing ureterorenoscopy for ureteric calculi resulting in failed access for which a Double-J stent will have to be introduced to avoid ureteric injury. This possibility of occurrence of a “difficult ureter” and a staged ureterorenoscopy after 2 to 3 weeks should be discussed with the patients preoperatively, in order to avoid patient dissatisfaction after the procedure and allay his undue emotional suffering.Haroon Sabir KhanMalik Nadeem Azam KhanFaisal HanifArmy Medical College Rawalpindiarticledifficultpre-stentingureterMedicineRMedicine (General)R5-920ENPakistan Armed Forces Medical Journal, Vol 68, Iss 5, Pp 1414-1418 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	difficult pre-stenting ureter Medicine R Medicine (General) R5-920
spellingShingle	difficult pre-stenting ureter Medicine R Medicine (General) R5-920 Haroon Sabir Khan Malik Nadeem Azam Khan Faisal Hanif PRE-STENTING IN A DIFFICULT URETER: WHAT IS THE INCIDENCE?
description	Objective: To estimate the occurrence of “difficult ureter” where stenting was performed as a preliminary step for passive ureteric dilatation before second ureterorenoscopy and to create awareness of the incidence of this abnormality in our setting. Study Design: Cross sectional prospective case review study. Place and Duration of Study: Study was conducted in Urology department of PNS Shifa Karachi, from Jul 2017 to Mar 2018. Material and Methods: All patients who presented to our institute for ureteric calculi with normal creatinine and no urosepsis were included in the study. The procedure was carried out either in spinal anesthesia or general anesthesia using laryngeal mask. The outcome data of ureterorenoscopyin all patients including those patients who required pre-stenting for difficult ureters were documented. Results: Ureterorenoscopy was performed in 164 patients (mean age 34 years, range 14 to 70 years) for treatment of ureteric calculi. Among these 29 patients (17.7%) had upper, 52 patients (31.7%) had middle and 83 patients (51%) had lower ureteric calculi. Stone clearance was achieved in 135 (82%) of patients. In 16 (9.7%) patients the stone had to be pushed back for Extracorporeal Shock Wave Lithotripsy later. “Difficult ureters” were encountered in 13 patients (7.9%) in which Double J stents were placed under fluoroscopy and staged successful ureterorenoscopy were performed after 2 to 3 weeks without any complication. Conclusion: There was a 7.9% (about 8%) incidence of encountering “difficult ureter” while performing ureterorenoscopy for ureteric calculi resulting in failed access for which a Double-J stent will have to be introduced to avoid ureteric injury. This possibility of occurrence of a “difficult ureter” and a staged ureterorenoscopy after 2 to 3 weeks should be discussed with the patients preoperatively, in order to avoid patient dissatisfaction after the procedure and allay his undue emotional suffering.
format	article
author	Haroon Sabir Khan Malik Nadeem Azam Khan Faisal Hanif
author_facet	Haroon Sabir Khan Malik Nadeem Azam Khan Faisal Hanif
author_sort	Haroon Sabir Khan
title	PRE-STENTING IN A DIFFICULT URETER: WHAT IS THE INCIDENCE?
title_short	PRE-STENTING IN A DIFFICULT URETER: WHAT IS THE INCIDENCE?
title_full	PRE-STENTING IN A DIFFICULT URETER: WHAT IS THE INCIDENCE?
title_fullStr	PRE-STENTING IN A DIFFICULT URETER: WHAT IS THE INCIDENCE?
title_full_unstemmed	PRE-STENTING IN A DIFFICULT URETER: WHAT IS THE INCIDENCE?
title_sort	pre-stenting in a difficult ureter: what is the incidence?
publisher	Army Medical College Rawalpindi
publishDate	2018
url	https://doaj.org/article/8430669c63d04c18bdf25553cad8c85c
work_keys_str_mv	AT haroonsabirkhan prestentinginadifficultureterwhatistheincidence AT maliknadeemazamkhan prestentinginadifficultureterwhatistheincidence AT faisalhanif prestentinginadifficultureterwhatistheincidence
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PRE-STENTING IN A DIFFICULT URETER: WHAT IS THE INCIDENCE?

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