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287 HOSSAIN, S.; SALAM, M.A.; day after surgery with a plane film and
KHAN, S.A. & HOSSAIN, A.Z.M.Z. (Dept. found 100% stone clearance.
of Urology, Dhaka Medical College, Dhaka). USE
OF HOLMIUM: YAG LASER LITHOTRIPSY Ureteroscopy and Lithotripsy using the
FOR TREATMENT OF URETERAL STONES. Holmium: YAG Laser is effective and safe
Bang.Med. J., 2006, 35 (2), 61-62. in terms of rapid fragmentation and
clearance for the treatment of ureteric stone.
For stone fragmentation a variety of Chance of stone migration is negligible.
lithotripter can be used. Though widely used,
urologists are facing various complications 288 JAHAN, S.; HOSSAIN, M.M. (Dept.
with pneumatic lithotripsy e.g. ureteal injury, of Pediatrics Nephrology, Bangabandu
bleeding and ureteral perforations during the Sheikh Mujib Medical University, Shahbag,
procedure. Dhaka) & ISLAM, M.S. (Dept. of Urology,
Bangabandhu Sheikh Mujib Medical
Since 1990 the Holmilum: YAG Laser has University, Shahbag, Dhaka). Spot urinary
been used in urology for stone fragmentation protein/osmolality ratio as a predictor for
with better outcome because thermal effect is proteinuria of nephrotic range. Bang. Med. Res.
limited to a few millimeters with a penetration Counc. Bul., 2007, 33 (2) 65-68.
depth of only 0.5 mm. The purpose of this
study is to evaluate the lithotripsy quality the A prospective study was carried out on 50
use Holmium: YAG Laser and its outcome for patients (age 1-15 years) with nephrotic range
the treatment of ureteral stone. of proteinuria to determine the correlation of
24-hour urinary total protein with spot urinary
urinary
and
ratio
protein
/creatinine
The researchers treated 30 patients, male 24 protein/osmolality ratio. Another 50 patients
and female 6, age 20 to 50 years, between having no proteinuria grouped as control.
March 2004 to January 2006 using the Twenty-four hours urine and spot urine were
Holmium: YAG laser under spinal anaesthesia. collected from each child and were analyzed for
All cases were purposively selected from OPD total volume, total protein, creatinine and
by evaluating IVU, stone size 6 mm to 20 mm, osmolality level. The average 24-hour urinary
23 cases in distal and 7 in proximal ureter. total proteins in nephritic patient were 2148.6 ±
808.7 mg and the spot urinary protein/creatinine
A semirigid ureteroscope was introduced in and spot urinary protein/osmolatity were 3.2332
the ureter with the help of guide wire until the ± 0.4293 mg/mg and 3.2418 ± 0.4393
stone is identified through which a 365 µm mg/mOsm respectively. There was a strong
positive correlation of the 24-hour urinary total
laser fiber was passed and stone was protein with spot urinary protein/creatinine and
fragmented into tiny pieces. All fragments protein/osmolality ratios (r= 0.9846 and 0.9870,
came out spontaneously and dormia basketery p =<0.001). But in control group, these ratios
was not required but in 4 cases. D-J stenting did not show any correlation with 24-hour
was done in 6 patients. urinary total protein. These results suggest that
in pediatric patients with nephrotic range of
Neither Ureteral injury nor perforation was proteinuria, the spot urinary protein/osmolality
observed during the procedure in any cases. ratio can predict the 24-hour urinary total
Stone fragmentation and extraction was easier, protein excretion like that of spot urinary
quicker and dormia basketery was not required protein/creatinine ratios.
except in 4 patients. Only 6 patients were
stented.Operation time range from 15-90 289 KABIR, A.K.M.N.; KAMAL, M.
minutes. The patients were evaluated on the (Dept. of Pathology, Bangabandhu Sheikh Mujib
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