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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

Receiver operating characteristics curve constructed using cut off values for stone size
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Figure 3: Receiver operating characteristics curve constructed using cut off values for stone size

Mentions: Pre-procedural characteristics of patients in both groups are shown in Table 1. There were no significant pre-treatment group differences in the CT appearance of the region of ureteric orifice (P - 0.789). Although, the number of patients with multiple calculi was more in the study group compared to control (25.40% vs. 11.11%), but it was not statistically significant (P - 0.063). Table 2 shows the intra-procedural parameters in both groups. Intra-operatively, patients with inflamed and or obliterated ureteric orifice were higher in the control group (P - 0.016). An exit strategy was considered in 7.94% of cases in the control group for failing negotiation of URS, but found to be not statistically significant (P - 0.057). Severe procedure related pain and mean operative time was less in the study group compared to control (P - 0.020 and 0.031, respectively). Post-operative characteristics are shown in Table 3. Stone free rate in the study group was higher than the control group (95.24% vs. 82.54%) and found to be statistically significant (P - 0.044). According to the Revised Clavien-Dindo classification, there were grade I and II complications in 17 patients (26.98%) and 12 (19.04%) patients among the study group, whereas 10 patients (15.87%), 15 patients (23.81%) and 1 patients (1.59%) in the control group had grade I, grade II, and grade IIIa complications respectively. However, none of them developed grades IV and V complications. Table 4 shows the correlation between pre-operative parameters and endoscopic characteristics of ureteric orifice. We found that CT appearance (r - 0.399) and stone size (r - 0.410) strongly correlate with the endoscopic findings (P - 0.001). A cut-off value of 10.24 mm for UVJ calculus showed sensitivity and specificity of 66.70% and 80.40%, respectively for prediction of inflamed and or obliterated ureteric orifice [Figure 3].


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)

Receiver operating characteristics curve constructed using cut off values for stone size
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Receiver operating characteristics curve constructed using cut off values for stone size
Mentions: Pre-procedural characteristics of patients in both groups are shown in Table 1. There were no significant pre-treatment group differences in the CT appearance of the region of ureteric orifice (P - 0.789). Although, the number of patients with multiple calculi was more in the study group compared to control (25.40% vs. 11.11%), but it was not statistically significant (P - 0.063). Table 2 shows the intra-procedural parameters in both groups. Intra-operatively, patients with inflamed and or obliterated ureteric orifice were higher in the control group (P - 0.016). An exit strategy was considered in 7.94% of cases in the control group for failing negotiation of URS, but found to be not statistically significant (P - 0.057). Severe procedure related pain and mean operative time was less in the study group compared to control (P - 0.020 and 0.031, respectively). Post-operative characteristics are shown in Table 3. Stone free rate in the study group was higher than the control group (95.24% vs. 82.54%) and found to be statistically significant (P - 0.044). According to the Revised Clavien-Dindo classification, there were grade I and II complications in 17 patients (26.98%) and 12 (19.04%) patients among the study group, whereas 10 patients (15.87%), 15 patients (23.81%) and 1 patients (1.59%) in the control group had grade I, grade II, and grade IIIa complications respectively. However, none of them developed grades IV and V complications. Table 4 shows the correlation between pre-operative parameters and endoscopic characteristics of ureteric orifice. We found that CT appearance (r - 0.399) and stone size (r - 0.410) strongly correlate with the endoscopic findings (P - 0.001). A cut-off value of 10.24 mm for UVJ calculus showed sensitivity and specificity of 66.70% and 80.40%, respectively for prediction of inflamed and or obliterated ureteric orifice [Figure 3].

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