Adherence to Hippocratic Oath in the Treatment of Urinary Tract Stones by Minimally Invasive Surgery; A five Years Experience in Dar es Salaam, Tanzania

Abstract

Background: Minimally invasive treatment – (referring to endoscopic,  laparoscopic and shockwave procedures) have made open surgery for stones nearly obsolete hence adhering to the father’s of medicine that not to provide treatments which are pointless or harmful. The development of shock wave lithotripsy, percutaneous nephrolithotomy techniques and intracorporeal lithotripsy devices has conferred unprecedented  management tools for upper tract stones. With experience, successful stone retrieval has occurred in upwards of 90% of cases, again with  minimal complications. Moreover, transfusion rates, hospital costs, and convalescence periods have been markedly reduced when compared to open surgery.
Objective: This study aimed to document the profile and outcome of patients treated for urinary tract stones by minimally invasive approach at Apollo Medical Centre – Dar-es-salaam, for five years being an experience in a typical third world environment.
Methods: This was a five years hospital based descriptive, combined retrospective and prospective study conducted by using a structured data collecting tool. The data were analyzed using SPSS software.
Results: A total of 281patients treated for urinary tract stones by minimally invasive approach in a period of five years were enrolled, of which 204 were retrospective, and 77 patients were prospective. Males were the majority at 66.9% (188) giving M:F ratio of 2:1. Majority of the patients, 274 (80%) were over 30 years of age. Renal stones were the commonest at 45.5% with ESWL being the most popular procedure performed in 47.7% of all patients. ESWL had a success rate of 70.7%, lower than contact lithotripsy and forceps picking. Only 4.6% complication rate was reported, both being minor.
Conclusions: the prevalence of urinary tract stones is increasing among female. Our patients deserve the benefits of minimally invasive techniques in the management of urolithiasis as they have been demonstrated to be feasible, safe and ESWL non-technically demanding.

Key words; Minimal invasive treatment, Urinary stones, Complications, Success