Diagnosis and Uretheroscopy Undeleayed Therapy of Complicated Uretheral Calculosis

Abstract

Diagnosis and therapy of uretheral calculosis have developed considerably with the introduction of new technologies. We attempted to verify whether their combined use can produce a quick and invasive-less solution, to complicated uretheral calculosis (persistent pain, marked hydronefrosis and/or infection).

23 patients showing complicated uretheral calculosis, underwent echography wich revealed medium grade hydronefrosis in 10 of them, and high grade hydronefrosis in 13. 15 had a body temperature higher than 38 °C. We immediately carried out infusional and antibiotic therapy and spiral TC without contrast within 24 hours. TC documented lithiasis of the pelvic urether in 12 cases, lithiasis of the medium lumbar urether in 9, and lithiasis of the proximal urether in 2. Diameter of stones was from 5 to 10 mm. Within the following 24 hours we performed a uretheroscopy with ballistic wave lithotripsy. The uretheral catheter was taken out the next day. After ecographic check 18 patients were given medical therapy and sent home, while 5 patients underwent infusional therapy for 3 days in day-hospital. Clinical, ecographic and radiographic check after one month showed complete regression of pain, hydronefrosis and infection. First choice treatment for uretheral stones is ESWL, however since the machine is not always available and the success rate is about 50–60% we resolved to carry out a combined treatment for complicated uretheral lithiasis, which enabled us to treat complicated colic in 72 hours, which proved effective both in terms of time saving and patients disconfort as opposed to a deferred treatment. We therefore propose this procedure as first choice for this type of sindrome, also taking into account that the necessary endoscopic instrumentation is always readily available.