CONSERVATIVE MANAGEMENT OF UROLITHIASIS: A PILOT STUDY
[Dr. Mir Nazir Ahmed, MS, Prof of Surgery, Govt. Medical College & SMHS Hospital, Srinagar, Kashmir, J&K.]
[Dr. G.M. Naikoo, PG Scholar, Dept. of Surgery, Govt. Medical College & SMHS Hospital, Srinagar, Kashmir, J&K. ]
INTRODUCTION:
Nephrolithiasis is a world wide problem with a prevalence rate of 2.3%. Patients between the ages of 20-50 years have peak incidence of stone formation.
Management of Urolithiasis has always been a complex issue and mostly depends upon the size, location and composition of stone.
MATERIAL AND METHODS:
The present study was conducted at the postgraduate department of surgery SMHS Hospital Govt. Medical College Srinagar, J&K..
A total of 60 patients were selected from the OPD clinic out of which a total of 50 Patients were available for complete follow up. The Patients were analyzed with respect to age, sex, residence, occupation, marital status. After obtaining written consent a complete history was taken and the patients were examined thoroughly. The patients were then subjected to various investigations which concluded, a complete blood count, kidney function testes, Blood Sugar, Serum Electrolytes, Urine exam, Ultrasound examination and KUB, IVP whenever needed. The patients with renal, uretric & vesicle stones were selected for the study and where given two capsules of Ural twice daily for two months & were followed up fortnightly for another 2 months.
AIMS AND OBJECTIVES:
To investigate the efficacy, safety and tolerability of Ural in patients with Urolithiasis in Kashmir .
OBSERVATIONS & RESULTS:
A total of 50 patients were followed for a period of two months after giving two capsules of Ural twice daily for two month as per study protocol. Out of the 50 patients 27 (54%) were males and 23 (46%) were females; and (52%) were married and 24 (46%) were unmarried. These patients were of difference age groups as indicated below in table 1.1.
| Table 1.1 |
Age in yrs. |
Up to 20 |
21-40 |
41-60 |
>60 |
No. patients |
8 |
30 |
12 |
None |
% age |
16% |
60% |
24% |
None |
|
The patients had different presenting complaints, summarized in table 1.2
| Table 1.2 |
| Symptoms |
No. of Patients |
%age of Patients |
| Pain* |
44 (Total) |
88% |
| R Flank |
23 |
45% |
| L Flank |
09 |
18% |
| B.L.Flank |
08 |
16% |
| Lower Abd. |
03 |
06% |
| Diffuse Abd. |
01 |
02% |
| Hematuria |
19 |
38% |
| Dysuria |
31 |
62% |
| Fever |
8 |
16% |
| Passage of grares |
1 |
2% |
| Miscellaneous* |
11 |
22% |
|
- Out of 88% of patients who presented with pain 11.36% had colicky pain and 84.09% presented as dull aching pain while 4.5% presented with other form of pain.
- Miscellaneous symptoms included frequency of micturition, arrangury nausea, vomiting etc.
The results of the investigations are as shown in table 2.1 - 2.3
Table: 2.1. (Haemogram) |
| Hb.gm% |
Upto 10.9 |
11-13.9 |
>14.0 |
No of patients |
16 |
32 |
2 |
% age of patients |
32 |
64 |
4 |
|
| Table 2.2 (Urine Analysis) |
|
Before Treatment |
After Treatment |
Pus Cell per HPF |
No. of patients
(38 Total) 76% |
No of patients |
0-6 |
13 |
2 |
7-12 |
8 |
4 |
11-20 |
8 |
4 |
>20 |
9 |
5 |
RBC Per HPF |
19 (38%) |
7 |
0-6 |
8 |
1 |
7-12 |
4 |
2 |
11-20 |
5 |
3 |
>20 |
2 |
1 |
|
Table 2.3 (Ultra sound findings) |
Presence of stone |
No. of Patients |
%age |
R. Kidney |
18 |
36 |
L. Kidney |
17 |
14 |
Bilateral |
12 |
24 |
R. Ureter |
05 |
10 |
L. Ureter |
6 |
12 |
Vesical |
1 |
2 |
|
Note: Hydronephrosis was present in 4 (8%) of patients
After treating the patient with the predefined treatment regimen, the following results were obtained. With regard to symptoms 43.48% of patients had pain relief, in 66.66% of patients Dysuria got relieved, fever got relieved 75% of patients & miscellaneous symptoms in 63.5% patients as shown in table 3.1
| Table 3.1 |
| Symptoms |
Total No. of pts with the symptom before treatment |
No. of patients relieved of the symptoms |
%age |
Pain |
44 |
19 |
43.8 |
Hematuria |
19 |
12 |
63.15 |
Dysuria |
31 |
19 |
61.29 |
Fever |
8 |
6 |
75% |
Miscellaneous |
11 |
7 |
63.63 |
|
Furthermore, out of 37 patients of renal stones 10.81% of the patient passed the stone spontaneously, during the treatment with Ural Capsule. With regard to ureteric stone, the success of spontaneous stone passage was achieved in two patients.
In most of the other patients, stone size got reduced.
DISCUSSION:
Urolithiasis has been encountered in various forms worldwide and continues to occupy a very important place in every day urological practice. It is because of this reason that our present knowledge needs to be evaluated with the changing trends in diagnosis & in treatment of Urolithiasis and drive insight, guidelines and recommendations for the same.
The present study was also carried out with the same intention and it was found that males and females were almost equally susceptible to Urolithiasis, as were the married and unmarried. The peak incidence was found to be in the age group of 20 to 40 years, which is consistent with world literature. The most common presenting complaint was pain (88%) which was more common on right side (46%) than in other parts. Almost 2/3 rd of the patients had associated symptoms of Dysuria and Hamaturia. The stone formation was more common in right kidney (36%).
After treating patients of Urolithiasis with Ural which contains Varuna, Kulatha & Gokshurak, 60-70% of the patients received significant symptomatic relief in pain (43.8%), Dysuria (61.29%), Fever (75%) Hematuria (63.15%) importantly both subjective as well as on microscopic examination of Urine. Pus count and RBC in urine has significantly reduced in most cases and also in total number of patients compared to before treatment.
CONCLUSION:
Based upon the above observations it can be safely concluded that the product Ural, containing Varuna, Kulatha & Gokshura, is effective in Urolithasis particularly in symptoms such as Pain, Dysuria / Hematuria etc. Side effects like mild epigastric discomfort nausea and vomiting were noticed in a few patients. However herewith we recommend double blind, multicentric trial involving larger group of patients for conclusive evidence.
Ural capsules can be one of the primary lines of treatment for small Calculi as well as for the patients where in surgery is unwarranted.
