Initial Results of Laser Ureteroscopy Treatment for Lithiasis of the Upper Urinary Tract at Aristide Le Dantec Hospital in Dakar (Senegal)

Abstract

Background: In Africa, lithogenesis was initially considered rare and it was mostly caused by infections. Recent studies suggest that obesity, change in dietary habits (milk, dairy products) and hot climate can contribute to an increase of the condition in the region. Over the past decades, the management of upper urinary tract urolithiasis has evolved significantly with minimally invasive techniques. The challenge for sub-Saharan countries is related with the acquisition and the training for minimally invasive treatment. In fact, open surgery has less indications in the management of urolithiasis. The aim of this study is to evaluate the preliminary results of ureteroscopic laser treatment for upper urinary tract lithiasis in our hospital.

Methods: This was a prospective, descriptive study realized between June 2016 and December 2018. The patients included were those who had ureteroscopic laser treatment for upper urinary tract lithiasis. The treatment was performed under general anesthesia by two surgeons. The studied parameters were: age, sex, patient medical history, comorbidities, renal function, cytobacteriological examination of urine, characteristics of lithiasis, intra and postoperative complications (using the Clavien–Dindo classification), ureteroscopic laser failures (frequency and causes). Success of treatment was defined by: the absence of a residual fragment at the renal and ureteral level or of a residual fragment <4 mm at the renal level on the control imaging. Data analysis was done with IBM SPSS Statistic 23 software. Statistical significance was considered when P < 0.05.

Results: This study involved 43 patients. The mean age was 40.84 years ± 15.33 years. The age group between 30 and 39 years was predominant. The sex ratio was 1.26. Nephritic colic was the circumstance of discovery in 93.02%. The Uro-CT scan performed in all our patients, revealed kidney stones in 16.3% and ureteral stones in 83.7%. The right side was the most involved in 55.8%. The mean size of the stones was 12.2 mm ± 4.89 at the renal level and 12.05 mm ± 5.54 at the ureteral level. The semi-rigid ureteroscope was used in 88.37% and the flexible ureteroscope in 11.63%. The lithiasis was visualized in 74.4% of cases. Laser fragmentation was performed in 69.77% of cases. A J stent was placed after 72.1% of cases. Pelvic ureteral stripping and pelvic ureteral aspiration were realized in one case each. Acute pyelonephritis (ANP) was observed in 25.6% of patients. There were 75% fragment free at postoperative control. Any factors associated with treatment failure were not found.