بررسی نتایج درمان سنگ حالب به روش سنگ‌شکنی از طریق داخل حالب(TUL) در مرکز آموزشی و درمانی شهید هاشمی‌نژاد

Transureteral lithotripsy(TUL) is a new approach to ureteral stones in Iran and relatively new method in other countries. The goal of the present study was to evaluate the first year of our experience with TUL in Shahid Hashemi Nejad Hospital. In this clinical trial study which was conducted from Sep. 2000 to Sep. 2001 a 8/5-10F Wolf semirigid ureteroscope and Swiss lithoclast and/or basket for removing ureteral stones were used in 270 cases. The patients were under investigation at least for 3 months. A questionnaire was developed which was completed by 100 patients. Based on completed questionnaires the results of TUL, success rate, complications regarding to stone characteristics were evaluated. Among 100 cases who completed 3-month follow-up, 75% were men (men/women: 3/1). Patients were from all age groups, from under 20 to over 60 (mean 41.6±3.4ys old). The most common groups were 40-50 years old cases and the least common ones were under 20. TUL was successful in 96 cases with no residual stone. In four cases, parts or all of the stone remained due to migration of stone up to calys. Two cases needed urgent open surgery because of ureteral perforation (one of them was already perforated before onset of ureteroscopy). Postoperative complications in patients were usually mild including: flank pain (23%), fever(12%) and hematuria(9%), which were all managed easily with conservative management. Three months after operation, IVU was done. The most common complication was incomplete disappearance of Hydronephrosis in 8%(4% stone rest, 3% memory of Hydronephrosis, 1% probable obstruction). Due to good results and few complications TUL seems a safe and effective method for lower and middle ureter stones. It can also be used for upper ureter stones when ESWL can not be done or is failed.