title: Role of steroidal anti-inflammatory agent prior to intracorporeal lithotripsy under local anesthesia for ureterovesical junction calculus: A prospective randomized controlled study.
abstract: OBJECTIVE
  The objective of the following study is to assess the effect of steroidal anti-inflammatory agent on the outcome of ureterorenoscopic lithotripsy (URSL) for ureterovesical junction (UVJ) calculus.
  
  
  METHODS
  This was a prospective randomized controlled study conducted at the Department of Urology, Regional Institute of Medical Sciences, Imphal.
  
  
  METHODS
  One hundred and twenty-six patients requiring ureteroscopic lithotripsy for UVJ calculus were randomly assigned into two groups. The study group received tablet deflazacort 30 mg once a day for 10 days prior to the procedure, whereas the control group did not receive such treatment. Parameters with respect to the outcome of the procedure were recorded for all patients in both groups.
  
  
  METHODS
  Fisher's exact and independent t-test was used to compare the outcome between the groups where P < 0.05 was considered to be statistically significant.
  
  
  RESULTS
  There was significant statistical difference (P - 0.016) on the endoscopic appearance of the region of ureteric orifice in patients receiving steroidal anti-inflammatory agent compared with control. Severe procedure related pain and mean operative time was less in the study group compared to control (P - 0.020 and 0.031, respectively). Re-treatment rates in the study group were lower than the control group (4.76% vs. 17.46%) and found to be statistically significant (P - 0.044). It is found that computed tomography (CT) appearance (r - 0.399) and stone size (r - 0.410) strongly correlate with the endoscopic findings of the region of UVJ (P - 0.001).
  
  
  CONCLUSIONS
  Inflamed and or obliterated ureteric orifice is the major constraints for stone clearance at ureterovesical junction. The present study showed the administration of tablet deflazacort (a steroidal anti-inflammatory agent) significantly improves the outcome of URSL under local anesthesia. We strongly recommend its use prior to URSL for UVJ calculus, especially for stone size ≥10.24 mm and on CT evidence of prominent soft tissue swelling at the UVJ.
authors.affiliation: Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
authors.forename: Bijit
authors.initials: B
authors.lastname: Lodh
authors.affiliation: Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
authors.forename: Kaku Akoijam
authors.initials: KA
authors.lastname: Singh
authors.affiliation: Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India.
authors.forename: Rajendra Singh
authors.initials: RS
authors.lastname: Sinam
keywords: Deflazacort; ureterorenoscopic lithotripsy; ureterovesical junction
references.citation: Rev Urol. 2006;8 Suppl 4:S35-42
references.pmid: 17216000
references.citation: Urology. 2000 Oct 1;56(4):579-82
references.pmid: 11018608
references.citation: Urol Clin North Am. 2004 Feb;31(1):157-71
references.pmid: 15040412
references.citation: CJEM. 2007 Nov;9(6):463-5
references.pmid: 18072994
references.citation: Radiol Clin North Am. 1999 Sep;37(5):911-52, v
references.pmid: 10494278
references.citation: Acta Neurol Scand. 1966;42:Suppl 20:53-60
references.pmid: 5940739
references.citation: Urol Int. 2004;72 Suppl 1:43-5
references.pmid: 15133333
references.citation: Int Urol Nephrol. 2005;37(2):235-41
references.pmid: 16142549
references.citation: Eur Urol. 2006 Aug;50(2):339-44
references.pmid: 16574310
references.citation: Am J Clin Nutr. 1978 Sep;31(9):1519-25
references.pmid: 685868
references.citation: BJU Int. 2009 Jun;103(12):1700-3
references.pmid: 19159408