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Dissertation
For
FCPS II (UROLOGY)
EFFICENCY AND COMPLICATIONS OF HO: YAG LASER
LITHOTRIPSY FOR URETEROSCOPIC REMOVAL OF
URETERAL CALCULI
By
Dr. Ali Hassan
Student of FCPS II (Urology)
Supervisor
Dr. Muhammad Muzammil Tahir
Associate Professor of Urology Department
Shaikh Zayed Hospital, Lahore.
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ii
CERTIFICATE
It is hereby certified that thesis is based on the results of experiments
carried out by Dr. Ali Hassan and that it has not been previously
presented for FCPS II. Mr. Ali Hassan has done this research work under
my supervision. He has fulfilled all the requirements and is qualified to
submit the accompanying thesis for the FCPS Urology.
Dr. Muhammad Muzamil Tahir
Associate Professor of Urology Department
Shaikh Zayed Hospital, Lahore.
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iii
ACKNOWLEDGEMENT
All thanks and praises to Almighty ALLAH, who enabled me to complete
my work.
I express my gratitude to Prof. Muhammad Muzammil Tahir for his
encouragement and guidance to pursue my post graduate studies.
Dr. Ali Hassan
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LIST OF ABBREVIATIONS
CI Confidence Interval
ESWL Extra Corporeal Shock Wave Lithotripsy
FPDL Flash-lamp Pumped Pulsed Dye Laser
Ho:YAG Holmium: Yttrium Aluminum Garnet
NA Numerical Aperture
OR Odds Ratio
PNL Percutaneous Nephrolithotomy
S.D Standard Deviation
SMA Subminiature Version A
SPSS Statistical Package for Social Sciences
SWL Shock Wave Lithotripsy
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TABLE OF CONTENTS
CHAPTER
I
ABSTRACT 1
II
INTRODUCTION 3
III
REVIEW OF LITERATURE 5
Ho: YAG Laser Lithotripsy 5
Current approaches of Laser Lithotripsy 19
Ureteric Calculi 22
Management of Ureteric Calculi 27
Proximal Ureteric Calculi 31
Mid Ureteric Calculi 35
Distal Ureteric Calculi 36
Options in the management of renal & ureteral stones in adults 38
IV
METHODS 52
Objectives 52
Operational Definitions 53
Study Design 54
Sample Selection 55
Data Collection Procedure 56
Data Analysis Procedure 57
V
RESULTS 58
VI
DISCUSSION 79
VII
CONCLUSION 84
VIII
REFERENCES 85
IX
PROFORMA 96
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LIST OF FIGURES
Figure-1: Optical intensity profiles of Ho:YAG Laser pulses
measured by a photo detector
Page# 8
Figure-2: Graphical presentation of different ages
Page# 61
Figure-3: Graphical presentation of different stone sizes
Page# 62
Figure-4: Graphical presentation of different Age groups
Page# 64
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vii
LIST OF TABLES
Table-1: Laser Lithotripsy Specifications
Page# 19
Table-2: Frequency distribution of Gender
Page# 60
Table-3: Descriptive statistics of different variables according
to Ureteric Calculi
Page# 63
Table-4: Frequency distribution of overall efficacy rate
Page# 65
Table-5: Frequency distribution of overall complications rate
Page# 66
Table-6: Frequency distribution of Stone Push Back
Page# 67
Table-7: Frequency distribution of Peritonitis
Page# 68
Table-8: Frequency distribution of genders according to
Ureteric Calculi
Page# 69
Table-9: Frequency distribution of efficacy according to
Ureteric Calculi
Page# 70
Table-10: Comparison of efficacy between Proximal and Distal
Ureteral calculi
Page# 71
Table-11: Stratification of Efficacy with respect to Gender
Page# 72
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viii
Table-12: Stratification of Efficacy with respect to Age
Page# 73
Table-13: Stratification of Efficacy with respect to Stone Size
Page# 74
Table-14: Stratification of Complications with respect to
Gender
Page# 75
Table-15: Stratification of Complications with respect to Age
Page# 76
Table-16: Stratification of Complications with respect to Stone
Size
Page# 77
Table-17: Stratification of Complications with respect to
Ureteric Calculi
Page# 78

Unformatted Attachment Preview

Dissertation For FCPS II (UROLOGY) EFFICENCY AND COMPLICATIONS OF HO: YAG LASER LITHOTRIPSY FOR URETEROSCOPIC REMOVAL OF URETERAL CALCULI By Dr. Ali Hassan Student of FCPS II (Urology) Supervisor Dr. Muhammad Muzammil Tahir Associate Professor of Urology Department Shaikh Zayed Hospital, Lahore. i CERTIFICATE It is hereby certified that thesis is based on the results of experiments carried out by Dr. Ali Hassan and that it has not been previously presented for FCPS II. Mr. Ali Hassan has done this research work under my supervision. He has fulfilled all the requirements and is qualified to submit the accompanying thesis for the FCPS Urology. Dr. Muhammad Muzamil Tahir Associate Professor of Urology Department Shaikh Zayed Hospital, Lahore. ii ACKNOWLEDGEMENT All thanks and praises to Almighty ALLAH, who enabled me to complete my work. I express my gratitude to Prof. Muhammad Muzammil Tahir for his encouragement and guidance to pursue my post graduate studies. Dr. Ali Hassan iii LIST OF ABBREVIATIONS CI Confidence Interval ESWL Extra Corporeal Shock Wave Lithotripsy FPDL Flash-lamp Pumped Pulsed Dye Laser Ho:YAG Holmium: Yttrium Aluminum Garnet NA Numerical Aperture OR Odds Ratio PNL Percutaneous Nephrolithotomy S.D Standard Deviation SMA Subminiature Version A SPSS Statistical Package for Social Sciences SWL Shock Wave Lithotripsy iv TABLE OF CONTENTS CHAPTER I ABSTRACT 1 II INTRODUCTION 3 III REVIEW OF LITERATURE 5 IV Ho: YAG Laser Lithotripsy 5 Current approaches of Laser Lithotripsy 19 Ureteric Calculi 22 Management of Ureteric Calculi 27 Proximal Ureteric Calculi 31 Mid Ureteric Calculi 35 Distal Ureteric Calculi 36 Options in the management of renal & ureteral stones in adults 38 METHODS 52 Objectives 52 Operational Definitions 53 Study Design 54 Sample Selection 55 Data Collection Procedure 56 Data Analysis Procedure 57 V RESULTS 58 VI DISCUSSION 79 VII CONCLUSION 84 VIII REFERENCES 85 IX PROFORMA 96 v LIST OF FIGURES Figure-1: Optical intensity profiles of Ho:YAG Laser pulses measured by a photo detector Page# 8 Figure-2: Graphical presentation of different ages Page# 61 Figure-3: Graphical presentation of different stone sizes Page# 62 Figure-4: Graphical presentation of different Age groups Page# 64 vi LIST OF TABLES Table-1: Laser Lithotripsy Specifications Page# 19 Table-2: Frequency distribution of Gender Page# 60 Table-3: Descriptive statistics of different variables according to Ureteric Calculi Page# 63 Table-4: Frequency distribution of overall efficacy rate Page# 65 Table-5: Frequency distribution of overall complications rate Page# 66 Table-6: Frequency distribution of Stone Push Back Page# 67 Table-7: Frequency distribution of Peritonitis Page# 68 Table-8: Frequency distribution of genders according to Page# 69 Ureteric Calculi Table-9: Frequency distribution of efficacy according to Page# 70 Ureteric Calculi Table-10: Comparison of efficacy between Proximal and Distal Page# 71 Ureteral calculi Table-11: Stratification of Efficacy with respect to Gender Page# 72 vii Table-12: Stratification of Efficacy with respect to Age Page# 73 Table-13: Stratification of Efficacy with respect to Stone Size Page# 74 Table-14: Stratification of Complications with respect to Page# 75 Table-15: Stratification of Complications with respect to Age Page# 76 Table-16: Stratification of Complications with respect to Stone Page# 77 Stratification of Complications with respect to Page# 78 Gender Size Table-17: Ureteric Calculi viii Name: Description: ...
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