Ureterolithiasis: Management in an environment with limited facilities

Abstract

Background: In the past 2–3 decades, there has been a dramatic development in the techniques of stone removal. This study highlights the management of symptomatic ureteral stones in an environment without such facilities.

Materials and Methods: Sixty‑nine patients, comprising 53 (76.8%) males and 16 (23.2%) females, diagnosed of symptomatic ureteric calculi within the study period in two tertiary health institutions were included in the study. Thorough history taking and physical examinations were performed. Extensive laboratory investigations using blood and urine specimens were carried out. Imaging studies, ultrasonography, intravenous urography, and computerized tomographic scan were used to locate the position and size of the calculi.

Results: Forty‑six (66.7%) patients presented with excruciating flank ureteric colic radiating to the groin in 16 (23.2%) patients and hematuria in 62 (89.9%) patients. Bilateral ureteric calculi occurred in 3 (4.3%) patients. Eleven (15%) stones passed spontaneously. 33 (47.8%) patients had uneventful open surgery. The stones were mixed in nature.

Conclusion: Management of ureteric stones in our environment is affected by delay in presentation, low level of awareness of urinary stone disease, lack of modern endourological equipment, and paucity of urological surgeons. Finally, medical treatment should be explored for stones below 10 mm in size.

Keywords: Ureteric colic, ureterolithiasis, ureterolithotomy