Syed Shahid Nafees, Nausheen Bakht, Nasimul Majid.
Nephropyelolithiasis: clinical presentation and management at CMH, Multan
Pak J Surg Oct - Dec 2005;21(2):60-4.
Combined Military Hospital, Rawalpindi

Objective: To determine the prevalence, clinical presentation, management and the role of diets, drugs and other factors in the development of nephropyelolithiasis. Design & Duration: Cross sectional analytical study conducted from June 1998 to December 2000. Setting: Department of Surgery, Combined Military Hospital, Multan. Patients: All patients who were admitted with renal stone disease. Methodology: Data of all the patients with nephrolithiasis was collected by a closed questionnaire and analyzed. Treatment consisted of emergency relief of pain as well as definitive treatment for stone removal. All surgeries were open due to non availability of minimally invasive procedures. High risk patients for recurrent stones were identified and underwent assessment of their metabolic profile. Precautionary methods and drugs were also used in high risk recurrent stone formers. Results: A total of 38000 cases were treated by the surgical department during the study period, out of which 700 cases were of nephropyelolithiasis; thus making a prevalence of 1 in 54.28 patients. Amongst these 469 (67%) were male and 231 (33%) female, with a mean age of 40 years (±30). Most i.e. 546 (78%) patients presented with renal colic, while 154(22%) had dull lumbar ache. About 450 (64.2%) patients were given emergency treatment and discharged, but 104 (14.8%) did not improve and had to be admitted. Amongst the investigations Intravenous Urography showed a sensitivity of 99% and was the best available imaging technique. Expectant treatment for small stones (<4mm) was successful in 14 (2%) patients, whereas 300 (42.85%) patients consented for surgery and under went nephropyelolithotomy, with partial nephrectomy in 50 (7.14%) cases. In 150 patients the stone was sent for chemical analysis which showed calcium oxalate to be the predominant variety. The evaluation for the risk factors, as well as urine and serum metabolic examination confirmed that 100 (14.7%) patients had secondary causes of stone formation. Conclusion: Nephropyelolithiasis can cause morbidity ranging from renal colic to renal failure, which can be treated by timely intervention. The patient should be counselled on the importance of early recognition, early reporting to hospital, and adopting preventive and prophylactic measures.

Category: Urology
Keywords: Nephropyelolithiasis. Renal Stones. Intravenous Urography. Nephrolithiasis.

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