Management of calcular anuria in adults caused by ureteric stones: By using of ureteroscopy and holmium laser

• Published in: Arab Journal of Urology 2011-09, Vol.9 (3), p.179-182
• Main Author: Abdel-Kader, Mohammad S.
• Format: Article
• Language: English
• Subjects: Adults; Anuria; Holmium laser; STONES/ENDOUROLGY Original; Ureteric calculi
• ISSN: 2090-5998; 2090-598X; 2090-598X; 2090-5998
• DOI: 10.1016/j.aju.2011.09.004

Purpose: To present our clinical outcomes in the management of anuria in adult patients caused by ureteral calculi by using of ureteroscopy and holmium laser. Materials and methods: Nineteen patients presented with calcular anuria with age between 19 and 48 years. The presentation was anuria with serum creatinine levels were 2-5.5 mg% (mean 3.5) and hyperkalemia in nine patients (5.2-6.1 mmol/L). There were bilateral ureteric stones in 14 (73.7%) and unilateral in five (26.3%) with single functioning kidney. Thirty-three ureteroscopic procedures were performed for 19 patients including bilateral ureteroscopy in 14. Laser lithotripsy was delivered using holmium laser via 356 lm laser fibre, with energy (1-1.2 J) and pulse rate (10 Hz). Post-operatively, monitoring of urine output, serum creatinine and K levels was done until normal values were obtained. Results: Ureteroscopy was performed for all 19 patients (33 procedures), but laser lithotripsy was done successfully in 30 procedures. The operative time was 46 min (25-70). The successful fragmentation rate was (100%). The stone-free rate was 90.9%. There were mucosal abrasions in 6 (31.5%), and mild to moderate haematuria in 9 (47.4%), and high fever in two patients (10.5%). Serum creatinine and potassium levels returned to normal within 7-10 days. Urine output gradually reached normal level within a week. Conclusions: Ureteroscopy and holmium laser lithotripsy represent an effective and safe modality for treatment of anuria caused by ureteral calculi.