Comparing Ureteral Catheterization's Impact on Flank Pain Post Ureteroscopic Stone Management
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Abstract
Background: Urolithiasis, or kidney stone disease, is a prevalent condition that poses significant challenges in urological practice. The management of ureteral stones, particularly through ureteroscopy, is a common intervention. The use of short-term ureteral catheterization as a postoperative pain management strategy following ureteroscopic stone removal has been a subject of debate, with limited evidence on its efficacy and necessity.
Objective: This study aimed to evaluate the effectiveness of short-term ureteral catheterization in reducing postoperative flank pain compared to non-catheterization in patients undergoing uncomplicated ureterolithotripsy for the management of distal ureteral stones.
Methods: A prospective, randomized, controlled trial was conducted at Liaquat National Hospital, Karachi, from January to July 2013, involving 60 patients aged 15-70 years with distal ureteral stones less than 1.0 cm. Patients were randomized into two groups: Group A received short-term ureteral catheterization, and Group B did not. The primary outcome measured was the reduction in mean pain score by at least 4 points from the baseline at every 6-hour interval for the first 24 hours post-procedure. Statistical analysis was performed using SPSS version 25, applying chi-square tests, independent sample t-tests, and Mann-Whitney tests, with a p-value of less than 0.05 considered significant.
Results: Both groups demonstrated a significant reduction in pain scores at 12, 18, and 24 hours post-operation. However, there was no significant difference in pain reduction between the catheterized (Group A) and non-catheterized (Group B) groups, with p-values of 0.55 for efficacy in pain reduction. The mean age, stone size, and postoperative hospital stay did not significantly differ between the groups, indicating that short-term ureteral catheterization did not offer additional benefits in managing postoperative pain or recovery.
Conclusion: Short-term ureteral catheterization following uncomplicated ureterolithotripsy does not significantly improve pain management compared to non-catheterization. This suggests that routine catheterization may be unnecessary, potentially leading to a paradigm shift in postoperative care for patients undergoing ureteroscopic stone removal. Future studies with larger sample sizes and long-term follow-up are needed to further validate these findings.
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References
Bhojani N, Bjazevic J, Wallace B, Lee L, Kaler KS, Dion M, et al. UPDATE–Canadian Urological Association guideline: Evaluation and medical management of kidney stones. Canadian Urological Association Journal. 2022;16(6):175.
Thongprayoon C, Krambeck AE, Rule AD. Determining the true burden of kidney stone disease. Nature Reviews Nephrology. 2020;16(12):736-46.
Imtiaz S, Alam A. Epidemiology and demography of Chronic Kidney Disease in Pakistan-A review of Pakistani literature. Pakistan Journal of Kidney Diseases. 2023;7(1):2-7.
Moftakhar L, Jafari F, Ghoddusi Johari M, Rezaeianzadeh R, Hosseini SV, Rezaianzadeh A. Prevalence and risk factors of kidney stone disease in population aged 40–70 years old in Kharameh cohort study: a cross-sectional population-based study in southern Iran. BMC urology. 2022;22(1):1-9.
Bhanot R, Jones P, Somani B. Minimally invasive surgery for the treatment of ureteric stones–state-of-the-art review. Research and Reports in Urology. 2021:227-36.
Kartal I, Baylan B, Çakıcı MÇ, Sarı S, Selmi V, Ozdemir H, et al. Comparison of semirigid ureteroscopy, flexible ureteroscopy, and shock wave lithotripsy for initial treatment of 11-20 mm proximal ureteral stones. Archivio Italiano di Urologia e Andrologia. 2020;92(1):39-44.
Yoon JH, Park S, Kim SC, Park S, Moon KH, Cheon SH, et al. Outcomes of extracorporeal shock wave lithotripsy for ureteral stones according to ESWL intensity. Translational andrology and urology. 2021;10(4):1588.
Bahçeci T, Kızılay F, Çal AÇ, Şimşir A. Comparison of shockwave lithotripsy and laser ureterolithotripsy for ureteral stones. J Urol Surg. 2021;8:167-72.
Sarwar MA, Khan F, Soomro N, Ahmed I, Aslam MM, Arain AA, et al. To compare the efficiencies of shock waves extracorporeal lithotripsies (ESWL) versus ureterorenoscopy (URS) to remove proximate ureteric stones. Journal of University Medical & Dental College. 2023;14(4).
Gupta P, Prabha V, Vernekar R, Devaraju S, Deole S, Adhikar P. Management of Ureteric Avulsion During Ureteroscopy: Our Experience in A Case Series. World Journal of Nephrology and Urology. 2020;9(2):45-51.
Paudyal P, Parmar K, Ranjan KR, Kumar S. Long segment right ureteric stricture following ureterorenoscopy for upper ureteric stone: A disastrous complication of endourology. Journal of Clinical Urology. 2023;16(1):70-4.
Kim HJ. Management of Complications Related to Ureteroscopy. Practical Management of Urinary Stone. 2021:113-9.
Motiwala F, Kucheria R. Ureteroscopy. Surgical Procedures for Core Urology Trainees. 2018:19-31.
Yamout H, Goldberg S. Genetic and Environmental Risk Factors for Kidney Stones. Nutritional and Medical Management of Kidney Stones. 2019:43-52.
Das DS. Comparative study to assess the relationship between Renal Calculi, Thyroid and Parathyroid Hormones and Urinary Infections at Tertiary Care Centre: Sree Mookambika Institute of Medical Sciences, Kulasekharam; 2019.
Meyers AM. The pivotal role of a kidney stone clinic in the management and prevention of recurrent calcium oxalate nephrolithiasis: University of the Witwatersrand, Faculty of Health Sciences, School of …; 2020.
Penniston KL, Nakada SY. Updates in the metabolic management of calcium stones. Current urology reports. 2018;19:1-11.
Howles SA, Thakker RV. Genetics of kidney stone disease. Nature Reviews Urology. 2020;17(7):407-21.
Curhan GC. Kidney stones in adults: Epidemiology and risk factors. UpToDate September. 2021;8.
Zielinski P, Krupinska J, Wrobel G. The impact of chemical compounds contained in a diet on the development and prevention of urolithiasis. Journal of Elementology. 2021;26(1).
Peerapen P, Thongboonkerd V. Kidney stone prevention. Advances in Nutrition. 2023.
Dahl NK, Goldfarb DS. Nutritional prevention and treatment of urinary tract stones. Nutritional Management of Renal Disease: Elsevier; 2022. p. 685-97.
Sangolli A, Ghagane SC, Nerli RB. Role of Dietary Supplements in Prevention of Renal Stones: An Update. B-Complex Vitamins-Sources, Intakes and Novel Applications: IntechOpen; 2021.
Boarin M, Villa G, Capuzzi C, Remon D, Abbadessa F, Manara DF. Dietary and lifestyle recommendations for urolithiasis prevention: a systematic literature review. International Journal of Urological Nursing. 2018;12(2-3):53-70.
Putman MS, Gordon CM. Pediatric Bone Drugs: Calcium and Vitamin D. Bone Drugs in Pediatrics: Efficacy and Challenges. 2014:153-81.
Ather MH, Nazim SM, Sulaiman MN. Efficacy of semirigid ureteroscopy with pneumatic lithotripsy for ureteral stone surface area of greater than 30 mm2. Journal of endourology. 2009;23(4):619-22.
Zia Q, Kiani F, Sajjad M, Nawaz M, Akmal M, Khurshid A, et al. Ambulatory Mini Percutaneous Nephrolithotomy (Mini-PCNL): Feasibility and outcomes in 1000 cases in Pakistan. Pakistan Armed Forces Medical Journal. 2020;70(2):469-73.
Djaladat H, Tajik P, Payandemehr P, Alehashemi S. Ureteral catheterization in uncomplicated ureterolithotripsy: a randomized, controlled trial. European urology. 2007;52(3):836-41.
Siddiq FM, Leveillee RJ. Complications of ureteroscopic approaches, including incisions. Advanced Endourology: The Complete Clinical Guide. 2006:299-320.
Akman Y, Liu W, Li Y. Functional reconstruction and trauma. Urology. 2001;57(319ą322):351ą4.
Hu JC, Silletti JP, Williams SB. Initial experience with robot-assisted minimally-invasive nephroureterectomy. Journal of endourology. 2008;22(4):699-704.