Management of Calculus Anuria Using Ureteroscopic Lithotripsy as a First Line Treatment: Its Efficacy and Safety

Purpose: To present our experience with emergency ureteroscopic lithotripsy (URSL) on ureteral stones related with acute kidney injury (AKI). Place and Duration: In the Department of Urology for three years duration from January 2019 to January 2020. Material and methods: We retrospectively analysed 27 patients consisting of 54 ureteral units (UU) undergoing URSL. There were 9 females and 18 males with M: F of 2:1 The anuria cause was bilateral obstruction with calculi in 21 cases, and unilateral obstruction with calculi in 33 cases with contralateral nephrectomy. In the same session, bilateral ureteroscopy was performed for bilateral synchronous ureteral stones. The anuria duration ranged from 12hours to 3-days. After the procedure, all patients ureteral stent were systematically removed. The operation was accomplished 6-12 hours afterward hospitalization. After surgery; all individuals were followed for minimum one-month. Results: A total of 27 urgent URSL were performed in 9 (33.3%) females and 18 (66.7%) males with an average age of 51 (range 32 to 73). Percutaneous nephrostomy was performed in 2 (7.4%) patients and in 2 (9.5%) patients with bilateral stones, the ureteral units (UU), severely wedged distal hard stones. These patients were candidates for open surgery, ureterolithotomy, 6 to 8 weeks afterward the initial intervention (PCN+ URSL). The improvements in renal function as demonstrated by post-obstruction diuresis and serum creatinine were compared in the two groups of patients using the Fisher's exact test. In 20 (71.1%) patients, URSL proved to be an effective therapeutic approach for obstruction removal and stone removal. Repeat surgery was required in 3 (11.1%). In 3 (11.1%) patients, URSL caused significant damage to the mucosa with a guide wire in the area of the damaged ureteral calculus. Ureteral stenting was sufficient to treat this complication. Stone or fragment migration was observed in 5 (18.5%) patients, all of which were in the upper stone position, and this procedure was the main reason of failure. In the first 24 hours, mild macroscopic haematuria was detected which did not require treatment. Postoperatively, 6 (22.2%) patients had high fever. Body temperature reversed back to usual within four days after getting the high dose and intravenous injection of a third-generation cephalosporin antibiotic (ureteral stent culture for Escherichia coli and positive urine culture). Conclusion: Calculus anuria is a therapeutic emergency that necessitates timely analysis and decompression management. URSL is the appropriate technique for designated patients and can be accomplished securely and has a high achievement rate with insignificant incidence of morbidity. Key words: Ureteral stones, ureteroscopy; surgery; kidneys, anuria, abnormalities; outcome and treatment.