Calculi Case Studies

ABSTRACT

BACKGROUND AND OBJECTIVES

Ureteral calculi has emerged as a global health issue. It is usually described as a loin acute pain radiating to the groin. Almost 20% of urinary stones are found in the ureters with majority (70%) being located in lower third of the ureter. The life time risk of developing urinary calculi is between 5 and 12%, affecting more men compared to women.

Various management options include- medical expulsion therapy (MET), extracorporeal shock wave lithotripsy (ESWL) and invasive therapies (ureteroscopy). Until 1980s, open surgical procedures were the mainstay of treatment of ureteric stone. In the last three decades, the management of urinary stone has undergone revolutionary change. Tamsulosin a selective alpha

Patients were followed for 7 to 10 days.

RESULTS:

In the study there were 46 males [24 in Group 1 and 22 in Group 2] and 14 Females [6 in Group 1 and 8 in Group 2]. The mean age of Group 1 was 43.20 ± 13.8 and mean age of group 2 was 40.27 ± 17.7. There was no significant difference in the sex and mean age between two groups.

In the study during the follow up 32 subjects expelled the calculi within 4-5 days, of which 26 were in Tamsulosin group and 6 were in Non Tamsulosin group.

This observation was statistically significant at 0.0001. Hence it can be said that with Tamsulosin treatment expulsion of distal ureteric calculi was higher than when compared to fluids with NSAID.

INTERPRETATION AND CONCLUSION:

Tamsulosin can be used as the first line of management for uncomplicated symptomatic distal ureteric calculi. It is effective and safe. Most of the patients treated with tamsulosin expelled the calculi within short duration. Keywords: Ureteric stones, Alpha 1 blocker, Tamsulosin,

The transport of stones from the kidney into the bladder and their movement through the ureter is accompanied by 3 basic factors -- 1) spasm of smooth muscles 2) submucosal edema and 3) Pain

In the transport of stones, the greatest obstacle is usually the terminal part of the ureters, mainly in the intra mural ‘detrusor tunnel’. Stones of size 4 mm or smaller pass spontaneously, although this is not without discomfort and expense to the patient. Ureteral calculi are often associated with renal obstruction conservative or active management should be carefully chosen to prevent irreversible damage to the kidney while choosing.

Interventional treatments comprise - medical expulsive therapy (MET), extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy, ureteroscopy and laparoscopic/open stone removal. Research to a large extent confirmed the ability of medical treatment to facilitate stone expulsion