الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 96 |  |  |
| | | from | 96 | | |
Abstract
Summary
This study was performed to compare the safety and efficacy of ureteroscopic management using Holmium: YAG laser lithotripsy versus shock wave lithotripsy for treating proximal ureteric stones more than 1cm.
It included 108 patients with upper ureteral stones and it was done in the period from January 2019 to October 2019 .
All Patients were preoperatively evaluated by medical history, physical examination including BMI, laboratory investigations including (urine analysis, urine culture, serum creatinine and routine pre-operative investigations), and imaging evaluation including (pelvic-abdominal ultrasound, KUB and Spiral C.T scans) for all patients.
Patients were randomized via sealed envelope system, achieving equal-sized treatment groups throughout the study.
SWL group included 54 patients were managed with electro-hydraulic Lithotripter and evaluated for anesthesia, position, maximum power, number of shocks, termination of procedure, need of jj, residuals, operative time, lithotripsy time, Intra operative complications, post-operative complications, hospitalization, KUB after 1 week, KUB 1 month later and need for other sessions.
URS group included 54 patients were managed with semi-rigid ureteroscopy with Ho: YAG LASER lithotripsy and evaluated for anesthesia, position, cystoscopy, ureteric orifice, guide wire passing, ureteral dilatation, intro uretroscope , energy, frequency, power, residuals and stone retrieval, operative time, termination of procedure, need of jj, intra operative complications, post-operative complications, hospitalization, KUB after 1 week and need for other sessions.
There was no significant difference between the two groups as regarding the patient characteristics as age, sex, presentation, BMI and past history in form of diabetes mellitus, hypertension, history of endo-urological and open surgical.
There was no significant difference between the two groups as regarding the stone characteristics as stone maximal diameter, HU and stone position opposite vertebrae.
There was significant difference between the two groups as regarding operation time p=0.001.
As regard post-operative complications there was no significant difference between the two groups as regarding renal colic and fever, while there was significant difference as regard stein strasse p= 0.01, hematuria p= 0.01 and voiding symptoms P=0.001.
In the SWL group 49 (90.74%) of 54 patients were stone-free after three sessions.
In URS groups 47 patients (87.04%) were stone-free. 7 failures (12.96%) in the semi-rigid URS group, the most frequent cause was stone migration into the kidney (n=4, 7.4%), stone not accessible because of ureteric stricture (n=3, 5.56%) .
For SWL group auxiliary procedures included jj stenting 1 patient post-operative due to fever.
For URS group auxiliary procedures included jj stenting 41 patients (intra operative).