Mohammad Shahzad Anwar, Tariq Ghafoor, Mohammed Tariq, Saeed Akhtar Malik.
Management of ureteric calculus renal failure: a cost effective and decision making analysis with and without percutaneous nephrostomy.
J Sheikh Zayed Med Coll Jan ;2(1):136-9.

Background: Calculus acute renal failure is a urological emergency. Prompt treatment in the form of either temporary urinary diversion, or definite treatment can save the patients from developing chronic renal failure.Objectives: To compare the management of patients with obstructive uropathy with and without percutaneous nephrostomy. Patients & methods: A prospective interventional study conducted at SIMS/ SZMC, 2007-10. Twenty patients of ureteric calculus presenting with acute renal failure were included in our study. Patients were divided into two groups. Age, sex, duration of anuria and biochemical profile like serum creatinine and serum potassium levels were noted in both groups. In group A, a preliminary percutaneous nephrostomy tube was placed as a temporary diversion. On normalization of clinical and biochemical profile, definite treatment in the form of ureterorenoscopy/ lithoclast was performed. In group B, all the patients underwent definite treatment in the form of ureterorenoscopy/ lithoclast without preliminary temporary urinary diversion. The duration of normalization of renal function test, efficacy of URS lithoclast, hospital stay and cost effectiveness in both the groups were noted. Results: A total of 20 patients with 75% male & 25% female were included. Duration of anuria in group A was one day in 1 patient and 2-3 days in 6 patients. The duration of anuria in group B was 1-2 days in 8 patients. Mean normalization of serum creatinine level in group A was 5.9 days while it was 5.2 days in group B. The mean hospital stay was 10 days in group A while it was 4.7 days in group B. The mean cost of treatment in group A was Rs.12300 and Rs.4800 in group B. Conclusion: In patients with deranged renal functions but otherwise clinically normal can be offered definite treatment without temporary diversion in the form of PCN. This not only decreases the morbidity associated with PCN but also comforts the patients in term of shorter hospital stay and cost effectiveness.

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