Emergency ureteroscopic – seem session treatment for calculus anuria. Experience of Belgrade hospital
Savic S., Vukotic V., Lazic M., Savic N.
Klinika za Urologiju, Clinical Hospital “Dr. Dragisa Misovic”, Belgrade, Serbia
Objective: to determine the efficacy, safety and outcome of emergency ureteroscopy (URS) for ureteral calculi that was associated with acute renal failure (ARF).
Patients and Methods: 59 patients /86 ureteral units (UU)/ who underwent URS for ARF: the cause of anuria was bilateral obstruction by the calculi in 27 cases, unilateral obstruction with /absent/ nephrectomised contralateral kidney in 32 cases were retrospectively evaluated. A standard dijagnostic algoritam was used before and after procedure. A semirigid ureteroscope was used in all cases and intracorporeal lithotripsy with electrokinetic energy was performed. The duration of anuria varied between 12 to 72 hours. All patients underwent surgery 6-12 hours after admission to hospital. Ureteral stent placement was performed in all cases after lithotripsy.
Results: The mean operative time was 26 minutes. The mean stone size was 9mm. The stone –free rate (SFR) were determined as a initial – on the first post operative day and as overall on the 30 days after procedure. SFR were observed according stone diameter and stone localization. The greatest success was achieved in the distal localization of stons up to 10mm. Normal renal function returned in 83% patients within 7 days. In 18.6% of UU we performed second procedure /SWL -16.3% or open surgery- 2.3%/. In 73% patients URS is successful therapeutic approach in dealing with: pain, obstruction and calculus.
Conclusion: Calculus anuria is medical emergrncy that requires rapid diagnosis and prompt treatment for the purpose of decompression. URS is the proper method of choice for selected patients.