To Determine the Outcomes of Transurethral Nephroscope For the Treatment of Large Vesical Stone With Using Pneumatic Lithoclast

Objective: T o study the determine the outcomes of transurethral nephroscope for the treatment of vesical stones using pneumatic lithoclast Methods : The detailed study was conducted in Department of Urology, Islam Medical & Dental College/ Islam teaching/Central hospital Sialkot, from March 2019-March 2020. A total of 25 males and 5 females with vesical stones greater then 4 cm that was fragmented using the through transurethral use of a nephroscope via 26F amlplatz sheath were enrolled. History from medical cards was obtained and physical examinations, lab tests, urine culture and ultrasonagraphy of urinary tract were conducted. Then the X-Ray KUB lm for stone clearance was used. The mean age, operation time, presenting symptoms, complications and the post operative status of the stone clearane was calculated and conducted analysis using SPSS version 21 Results : The mean age ± SD was noted to be 48.79±12.499 years and male to female percentage being 89% to 11%. The mean stone size was 4.53±0.38 cm and mean operation time was 48.79±8.73 minutes. Thirty-one patients (31%) developed retention of urine and straining during micturition in (17%), dribbling of urine (15%) , hematuria (10%), frequent urination(10%) and abdominal pain was reported in 15% patients. Ninety-six (96%) patients achieved the stone-free status and had no complications while only 1 patient had an intravesical bleeding. Conclusions : The treatment of large stone using a nephroscope via a transurethral amplatz sheath is an effective procedure and quick too. The Amplatz sheath helps in pneumatic lithotripsy is indeed an effective and safe procedure to be carry out in patients with large bladder stones.


M E T H O D S
Channa AA et al., 50-60 and 13% in 60-70 and 11% 70-80 years' age group. (Figure 1). tehncique of stone clearance aim to fragment the stone and make an easy passage with nominal morbidity and complications to the patient. In our study we will be assessing the outcomes of the transurethral using nephroscope for lrge bladder stones.
The comprehensive work was carried out in Department of Urology, Islam Medical & Dental College/ Islam Teaching Hospital and Islam cental Hospital Sialkot from 1st April 2019 to March 31st 2020, 25 males and 5 females presenting with vesical stones greater then 4 cm of age above 30 and less than 75 years were included. Medical history was talem from medical cards and conducted physical examinations, lab tests and urine culture and ultrasonagraphy of urinary tract. Then KUB lm was used post operatively for stone clearance. We noted the mean age, operation time, presenting symptoms and complications and the post operative status of the stone and conducted our analysis using SPSS version 21. Exclusion Criteria was past history of pelvic radiotherapy, abdominal surgery, distressed with hydronephrosis, severe renal problems and bladder tumors. The gender, mean age, operation time, stone size and presenting symptoms prior to surgery of the patients was recorded and also the resulting complications and stone-free status by periodical followups and analyzed the data using SPSS Version 21.

R E S U L T S
Out of the overall population the mean age ± SD was noted to be 48.79±12.499 years and with maximum and minimum age being 75 and 30. However it was mostly male dominated with male to female percentage being 89 to 11%. The mean stone size was 4.53±0.38 cm and mean operation time was 48.79±8.73 minutes (Table 1).

D I S C U S S I O N
Vescial stones usually affect men and according to a study and amount to about 5% of urinary stones.Mainly occurring due to bladder obstruction, infection or foreign bodies invasion [5,6]. Considering the development in this modality, many methods have been used to manage the stones in the bladder for instance Open cystolithotomy, extracorporeal shockwave lithotripsy, transurethral c ys to l i t h o t r i p sy a n d p e r c u t a n e o u s s u p r a p u b i c systolithotripsy however it highly depends on the surgeon and patients physical and medical history of presentation and test as to which method to be used.Yet transurethral nephroscope is the common method used worldwide as it allowed other devices like laser and pneumatic lithotripter for fragmentation and we have used pneumatic in our study [7,8] [11,12].
Most of the patients fell in the age bracket of 40-50 years and similar ndings were reported by with age of patients falling between 11 to 70 years. In our study the average time taken for fragmentation was 48.79 minutes while Rai et al.
[9] took 58 minutes . As such no particular aetiology can be associated for bladder calculi as supported by Okeke and his fellows in their study too [10,14]. Most patients achieved the stone-free status about 96% and had no complication while only 1 patient had an intravesical bleeding while shaikh and friends reported urethral in 7.5% and bladder bleeding 6% and only 3.5% had incidents of infection [15,16]. Ahmed Rasheed showed a stone did not break in 3.3% , 2.69% had partial fragmentation making a 84% stone free status while in our study stone free status was 96% [17,18]. Similarly Msihra and colleagues conducted their research using transurethral lithotripsy and reported no complications in all patients proving nephorsscope to be more effective [19,20]. Howeer we also showed that large fragments of stones can be prevented various entries to the urethra and the damage to the tract is also minimum [21,22].