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Role of steroidal anti-inflammatory agent prior to intracorporeal lithotripsy under local anesthesia for ureterovesical junction calculus: A prospective randomized controlled study.

Lodh B, Singh KA, Sinam RS - Urol Ann (2015 Apr-Jun)

Bottom Line: Re-treatment rates in the study group were lower than the control group (4.76% vs. 17.46%) and found to be statistically significant (P - 0.044).It is found that computed tomography (CT) appearance (r - 0.399) and stone size (r - 0.410) strongly correlate with the endoscopic findings of the region of UVJ (P - 0.001).The present study showed the administration of tablet deflazacort (a steroidal anti-inflammatory agent) significantly improves the outcome of URSL under local anesthesia.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.

ABSTRACT

Objective: The objective of the following study is to assess the effect of steroidal anti-inflammatory agent on the outcome of ureterorenoscopic lithotripsy (URSL) for ureterovesical junction (UVJ) calculus.

Settings and design: This was a prospective randomized controlled study conducted at the Department of Urology, Regional Institute of Medical Sciences, Imphal.

Subjects and methods: One hundred and twenty-six patients requiring ureteroscopic lithotripsy for UVJ calculus were randomly assigned into two groups. The study group received tablet deflazacort 30 mg once a day for 10 days prior to the procedure, whereas the control group did not receive such treatment. Parameters with respect to the outcome of the procedure were recorded for all patients in both groups.

Statistical analysis used: Fisher's exact and independent t-test was used to compare the outcome between the groups where P < 0.05 was considered to be statistically significant.

Results: There was significant statistical difference (P - 0.016) on the endoscopic appearance of the region of ureteric orifice in patients receiving steroidal anti-inflammatory agent compared with control. Severe procedure related pain and mean operative time was less in the study group compared to control (P - 0.020 and 0.031, respectively). Re-treatment rates in the study group were lower than the control group (4.76% vs. 17.46%) and found to be statistically significant (P - 0.044). It is found that computed tomography (CT) appearance (r - 0.399) and stone size (r - 0.410) strongly correlate with the endoscopic findings of the region of UVJ (P - 0.001).

Conclusions: Inflamed and or obliterated ureteric orifice is the major constraints for stone clearance at ureterovesical junction. The present study showed the administration of tablet deflazacort (a steroidal anti-inflammatory agent) significantly improves the outcome of URSL under local anesthesia. We strongly recommend its use prior to URSL for UVJ calculus, especially for stone size ≥10.24 mm and on CT evidence of prominent soft tissue swelling at the UVJ.

No MeSH data available.


Related in: MedlinePlus

Intensely inflamed ureteric orificeon endoscopy
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Figure 2: Intensely inflamed ureteric orificeon endoscopy

Mentions: Ureterovesical junction (UVJ) is the narrowest part of the human ureter that provides a gateway for stone lodgment and impaction. According to Peremans,[1] three zones can be distinguished in the ureterovesical junction namely the extravesical ureter at ureteral hiatus, intramural and submucosal part of the intravesical ureter [Figure 1]. Not surprisingly, in the era of minimally invasive surgery where ureteroscopic retrieval is the mainstay of treatment for lower ureteric calculus, difficulties are faced in dealing with UVJ calculus. This is largely because of complete or partial obliteration of the ureteric orifice following severe inflammation secondary to a calculus. Again, ongoing inflammation has been linked with an infection that perpetuate as a vicious cycle. Thus, it is not uncommon to view an obscure ureteric orifice during endoscopy in patients with radiological evidence of UVJ calculus [Figure 2]. In difficult cases, an exit strategy that allows return at a later date is the most appropriate decision from surgeons’ standpoint, but it is associated with poor patient compliance and overall increase in operating cost. There are no well-established pre-operative factors that can predict the success of stone clearance at ureterovesical junction. Therefore, our study was aimed to determine the role of steroidal anti-inflammatory agent on the outcome of ureteroscopic lithotripsy under local anesthesia for UVJ calculus and if so which subset of patients are likely to be benefited.


Role of steroidal anti-inflammatory agent prior to intracorporeal lithotripsy under local anesthesia for ureterovesical junction calculus: A prospective randomized controlled study.

Lodh B, Singh KA, Sinam RS - Urol Ann (2015 Apr-Jun)

Intensely inflamed ureteric orificeon endoscopy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374257&req=5

Figure 2: Intensely inflamed ureteric orificeon endoscopy
Mentions: Ureterovesical junction (UVJ) is the narrowest part of the human ureter that provides a gateway for stone lodgment and impaction. According to Peremans,[1] three zones can be distinguished in the ureterovesical junction namely the extravesical ureter at ureteral hiatus, intramural and submucosal part of the intravesical ureter [Figure 1]. Not surprisingly, in the era of minimally invasive surgery where ureteroscopic retrieval is the mainstay of treatment for lower ureteric calculus, difficulties are faced in dealing with UVJ calculus. This is largely because of complete or partial obliteration of the ureteric orifice following severe inflammation secondary to a calculus. Again, ongoing inflammation has been linked with an infection that perpetuate as a vicious cycle. Thus, it is not uncommon to view an obscure ureteric orifice during endoscopy in patients with radiological evidence of UVJ calculus [Figure 2]. In difficult cases, an exit strategy that allows return at a later date is the most appropriate decision from surgeons’ standpoint, but it is associated with poor patient compliance and overall increase in operating cost. There are no well-established pre-operative factors that can predict the success of stone clearance at ureterovesical junction. Therefore, our study was aimed to determine the role of steroidal anti-inflammatory agent on the outcome of ureteroscopic lithotripsy under local anesthesia for UVJ calculus and if so which subset of patients are likely to be benefited.

Bottom Line: Re-treatment rates in the study group were lower than the control group (4.76% vs. 17.46%) and found to be statistically significant (P - 0.044).It is found that computed tomography (CT) appearance (r - 0.399) and stone size (r - 0.410) strongly correlate with the endoscopic findings of the region of UVJ (P - 0.001).The present study showed the administration of tablet deflazacort (a steroidal anti-inflammatory agent) significantly improves the outcome of URSL under local anesthesia.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.

ABSTRACT

Objective: The objective of the following study is to assess the effect of steroidal anti-inflammatory agent on the outcome of ureterorenoscopic lithotripsy (URSL) for ureterovesical junction (UVJ) calculus.

Settings and design: This was a prospective randomized controlled study conducted at the Department of Urology, Regional Institute of Medical Sciences, Imphal.

Subjects and methods: One hundred and twenty-six patients requiring ureteroscopic lithotripsy for UVJ calculus were randomly assigned into two groups. The study group received tablet deflazacort 30 mg once a day for 10 days prior to the procedure, whereas the control group did not receive such treatment. Parameters with respect to the outcome of the procedure were recorded for all patients in both groups.

Statistical analysis used: Fisher's exact and independent t-test was used to compare the outcome between the groups where P < 0.05 was considered to be statistically significant.

Results: There was significant statistical difference (P - 0.016) on the endoscopic appearance of the region of ureteric orifice in patients receiving steroidal anti-inflammatory agent compared with control. Severe procedure related pain and mean operative time was less in the study group compared to control (P - 0.020 and 0.031, respectively). Re-treatment rates in the study group were lower than the control group (4.76% vs. 17.46%) and found to be statistically significant (P - 0.044). It is found that computed tomography (CT) appearance (r - 0.399) and stone size (r - 0.410) strongly correlate with the endoscopic findings of the region of UVJ (P - 0.001).

Conclusions: Inflamed and or obliterated ureteric orifice is the major constraints for stone clearance at ureterovesical junction. The present study showed the administration of tablet deflazacort (a steroidal anti-inflammatory agent) significantly improves the outcome of URSL under local anesthesia. We strongly recommend its use prior to URSL for UVJ calculus, especially for stone size ≥10.24 mm and on CT evidence of prominent soft tissue swelling at the UVJ.

No MeSH data available.


Related in: MedlinePlus