Comparative Study of Efficacy of Localization and Fragmentation of Renal Stone by USG And Fluoroscopy Guided ESWL

INTRODUCTION: Prior to the introduction of extracorporeal shockwave lithotripsy (ESWL) in 1980, the only treatment available for calculi that could not pass through the urinary tract was open surgery. Since then, ESWL has become the preferred tool in the urologist’s armamentarium for the treatment of renal stones, proximal stones, and midureteral stones. Compared with open and endoscopic procedures, ESWL is minimally invasive, exposes patients to less anaesthesia, and yields equivalent stonefree rates in appropriately selected patients. AIM AND OBJECTIVES: To compare the efficacy of localization and fragmentation of renal stone by USG and fluoroscopy in ESWL based on: 1. Location, 2. Size, 3. Mean distance between skin and stone (Morbid Obesity), 4. Radiolucency, 5. Anatomic factors, 6. Stent Placement. MATERIALS AND METHODS: STUDY DESIGN: This is a prospective study conducted in 110 patients of renal stone disease Based on ESWL done in department of urology, Govt. Royapettah Hospital and KMC Hospital, Chennai during the period January 2009 – January 2010. INCLUSION CRITERIA: 1. Patients with Renal stone 5mm – 2 cm in diameter in upper, middle calyx or Renal Pelvis and 1cm in lower calyx. Not an previously treated for the same. 2. All stone located in a satisfactory functioning non obstructed Renal unit. EXCLUSION CRITERIA: 1. Pediatric patients, 2. Bleeding diathesis, 3. Pregnant females, 4. Uncontrolled infection, 5. Ureteric calculi, 6. Distal obstruction, 7. Congenital Anomalies, 8. Patients with cardiac pacemaker, 9. Lower calyceal stone with unfavourable anatomy. RESULTS: 50 patients for USG guided and 50 patients for fluoro guided under went ESWL who had satisfied the inclusion and exclusion criteria mentioned earlier and later underwent. CONCLUSION: USG Guided ESWL is preferred option in all renal calculus. < 2 cm in renal pelvis, upper calyx and middle calyx, < 1 cm in lower calyx. It is a most preferred option in other following conditions like. 1. Clinically insignificant Residual fragment, 2. Paediatric groups, 3. Solitary Kidney, 4. Radiolucent stone, 5. Skin to stone mean distance < 10 cm, 6. Because of radiation hazard. In all group of patient No. of shocks is comparatively is less when compared to fluoroscopic guided ESWL. Fluoroscopy guided ESWL in renal calculus is a preferred option when it is difficult to localize by USG, Morbid obesity (Skin – stone distance > 10 cm in our study. Both ultra sound and fluoroscopic guided ESWL has its own advantages and disadvantages. Wherever USG guided ESWL is available it is the most preferred option. Wherever Fluoroscopy guided ESWL is available USG as a combined modality is an added advantage