A study on ureteric calculi in a rural tertiary care centre


  • Kailash Jagannath Department of General Surgery, PESIMSR, Kuppam, Chittoor, Andhra Pradesh, India
  • Ashwin Kanakaraja Gupta Department of General Surgery, PESIMSR, Kuppam, Chittoor, Andhra Pradesh, India
  • Narayanaswamy Srinivasan Department of General Surgery, PESIMSR, Kuppam, Chittoor, Andhra Pradesh, India




Ureteric calculi, URSL, PCNL/PBPCNL


Background: Urolithiasis is one of the most common afflictions of genito-urinary tract affecting almost 5-15% of the world population. Nearly 50% of patients affected will have recurrence within 5 years, making it a lifetime disease. This study was undertaken to know the clinical epidemiology and to evaluate different management modalities with immediate postoperative outcomes of ureteric calculi.

Methods: This was a descriptive prospective observational study done at PES Institute of Medical Sciences and Research, Kuppam for a period of 2 years. A set of inclusion and exclusion criteria were defined and followed. Initial assessment, basic investigations with specific investigations for ureteric calculi confirmation were done. Relevant operative procedure was done and patients were managed post operatively.

Results: The most common age group affected was between 31-50 years with male predominance in our study. Pain abdomen was the presenting complaints seen in all the patients. Lower 1/3rd of ureter was the commonly involved site. URSL (ureteroscopic lithotripsy) was the choice of treatment for ureteric and vesico-ureteric junction calculi and PCNL/PBPCNL (percutaneous nephrolithostomy/push back percutaneous nephrolithostomy) was the treatment of choice for calculi at pelvi-ureteric junction and upper 1/3rd of ureter with size >1 cm. The success rate of the surgical procedures done in our study was 80-100%.

Conclusions: Increasing prevalence of calculi in younger age group and in female population may be due to westernization, modern lifestyle and change in dietary habits. Having the knowledge of newer techniques will help surgeons to individualise the treatment which will improve success rate and reduce morbidity.


Author Biographies

Kailash Jagannath, Department of General Surgery, PESIMSR, Kuppam, Chittoor, Andhra Pradesh, India

Postgraduate Resident, Department of General Surgery

Ashwin Kanakaraja Gupta, Department of General Surgery, PESIMSR, Kuppam, Chittoor, Andhra Pradesh, India

Assistant Professor, Department of General Surgery


Moe OW. Kidney stones: pathophysiology and medical management. Lancet 2006;367(9507):333-44.

Trinchieri A, Coppi F, Montanari E, Del Nero A, Zanetti G, Pisani E. Increase in the Prevalence of Symptomatic Upper Urinary Tract Stones during the Last Ten Years. Eur Urol. 2000;37:23-5.

Qaader DS, Yousif SY, Mahdi LK. Prevalence and etiology of urinary stones in hospitalized patients in Baghdad. East Mediterr Health J. 2006;12:853-61.

Griffith DP. Infection-induced renal calc¬culi. Kidney international 1982;21(2):422–30.

Eskelinen M, Ikonen J, Lipponen P. Usefulness of history-taking, physical examination and diagnostic scoring in acute renal colic. Eur Urol. 1998;34:467-73.

Smith RD, Shah M, Patel A. Recent advances in management of ureteral calculi. F1000 Med Rep. 2009;1:53.

Miller NL, Lingeman JE. Management of kidney stones. BMJ. 2007;334:468-72.

Baily RR, Dann E. Urinary stones: A prospective study of 350 patients N2. Med J. 1974;79:961.

Hiatt RA, Dales LG, Friedman GD, Hunkeler EM. Frequency of urolithiasis in a prepaid medical care program. Am J Epidemiol. 1982;115:255-65.

Knoll T, Schubert AB, Fahlenkamp D, Leusmann DB, Wendt-Nordahl G, Schubert G. Urolithiasis Through the Ages: Data on More Than 200,000 Urinary Stone Analyses. J Urol. 2011;185(4):1304-11.

Lancina Martin JA, Rodriguez-Rivera GJ, Novas Castro S, Rodriguez Gomez I, Fernandez Rosado E, Alvarez Castelo L, et al. Metabolic risk factors in calcium urolithiasis according to gender and age of the patients. Actas Urologicas Espaniolas. 2002;26:111-20.

Tanthanuch M, Apiwatgaroon A, Pripatnanont C. Urinary tract calculi in southern Thailand. J Med Assoc Thai. 2005;88:80-5.

Lieske JC, Peña de la Vega LS, Slezak JM, Bergstralh EJ, Leibson CL, Ho KL, et al. Renal stone epidemiology in Rochester, Minnesota: an update. Kidney Int. 2006;69:760-4.

Safarinejad MR. Adult urolithiasis in a population-based study in Iran: prevalence, incidence, and associated risk factors. Urol Res. 2007;35:73-82.

Jeevaraman S, Selvaraj J, Mohammed Niyamathullah N. A study on ureteric calculi. Int J of Contemporary Med Res. 2016;3(10):2969-72.

Burkland CE, Rosenberg M. Survey of urolithiasis in the united states. J Urol. 1955;73(2):198-207.

Prince CL, Scardino PL. A statistical analysis of ureteral calculi. J Urol. 1960;83:561-5.

Reid M Morse and Martin I Resnick. Ureteral calculi: natural history and treatment in an era of advanced technology. J Urol. 1991;145:263-5.

Drach GW. Urinary lithiasis Chap 22 in Campells Urology. Harrison JH, et al (editors) Saunders; 1978: 779-878.

Higgins CC. Factors in the recurrence of renal calculi. JAMA. 1993;113:1460.

Galvin DJ, Pearle MS. The contemporary management of renal and ureteric calculi. BJUI. 2006;98:1283-8.

Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN, et al. The management of stone disease. BJU International. 2002;89(1):62–8.

Lieske JC, de la Vega LS, Gettman MT, Slezak JM, Bergstralh EJ, Melton LJ 3rd, et al. Diabetes mellitus and the risk of urinary tract stones: a population-based case-control study. Am J Kidney Dis. 2006;48(6):897-904.

Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293:455-62.

Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol. 1996;155:839-84.

Fink HA, Akornor JW, Garimella PS, MacDonald R, Cutting A, Rutks IR, et al. Diet, Fluid, or Supplements for Secondary Prevention of Nephrolithiasis: A Systematic Review and Meta-Analysis of Randomized Trials. Eur Urol. 2009;56(1):72-80.

Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J Urol. 1997;158(2):1915-21.

Peschel R, Janetschek G, Bartch G. Extracorporeal shock wave lithotripsy versus ureteroscopy for distal ureteral calculi: a prospective randomized study. J Urol. 1999;162(11):1909.

Erhard M, Salwen J, Bagley D. Ureteroscopic removal of mid and proximal ureteral calculi. J Urol. 1996;155(1):38–42.

Boline GB, Belis JA. Outpatient fragmentation of ureteral calculi with mani-ureteroscopes and laser-lithotripsy. J Endourol. 1994;8:341.

Grasso M, Beaghler M, Loisides P. The case for primary endoscopic management of upper urinary tract calculi: II. Cost and outcome assessment of 112 primary ureteral calculi. Urology. 1995;45:372.






Original Research Articles