Background: Endoscopic management of proximal ureteral calculus with new improved techniques have resulted in greater stone-free rates with low morbidity. However, problems remain preventing to achieve a 100% stone free rate with endoscopic management. One such problem is retrograde migration of proximal ureteric calculus during ureteroscopic lithotripsy. There are many retro-pulsion devices and maneuvers available and practiced nowadays. In this study we aim to assess the efficacy of stone cone in the ureteroscopic management of proximal ureteric calculus.
Methods: This is a prospective randomized control study conducted in the Department of Urology in Governtment K.A.P.viswanatham Medical College Hospital, Trichy during the period August 2016 - January 2018. 80 patients with proximal ureteric calculus who presented to our department were included in this study. Our patients were randomized into 2 groups with 40 patients in each group. In group 1, Ureteroscopic pneumatic lithotripsy of proximal ureteric calculus with the help of stone cone was done and in group 2, lithotripsy done without stone cone. Stone clearance rates were compared between the two groups and results were analysed.
Results: 80 patients with proximal ureteric calculus were randomly distributed into 2 groups. Group 1 included 40 patients who underwent ureteroscopic pneumatic lithotripsy with Stone Cone. The success rate in terms of complete stone clearance is 95% (38 out of 40) patients in the immediate postoperative period. Residual fragments up to 4 mm was noted in 2 cases. In Group 2 with 40 patients who underwent standard ureteroscopic pneumatic lithotripsy without stone cone were included. The stone clearance rate in this group is 70% (28 out of 40 patients) in the immediate postoperative period. 8 patients had stone migration into renal pelvis and 4 patients had residual fragments more than 4mm. Follow up after 1 month by KUB or spiral CT scan showed complete clearance of the stone in all 40 patients in the Stone Cone group. In group2, complete clearance of the stone occurred in 37 patients. Proximal stone migration was prevented in all patients in the stone cone group with 100% success rate versus without stone cone group (8 patients had stone migration into the kidney) with success rate of 80%. Success rate in terms of preventing stone migration showed Stone Cone group superior with a statistically significant difference (p < 0.05). Similarly, the stone-free rate in the Stone Cone group was 100% (40/40) versus 87.5% (35/40) in the other group in the one month follow up period.
Conclusion: Our study demonstrated superior proximal stone clearance rates when ureteroscopic lithotripsy was done with stone cone. It is also safe and efficient in preventing proximal stone migration. Hence it can be considered in managing upper ureteric calculus as an effective retropulsion device.
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