Stone Diseases in Algeria: URS Replaces Slowly Open Surgery

1. Algerian Association of Urology Stone Diseases in Algeria: URS Replaces Slowly Open Surgery H. KOUICEM, Algeria

2. Introduction In Algeria, urolithiasis is a wide-spread health problem. Until recently, stone diseases were almost exclusively treated via open surgery, due to financial restrictions leading to a lack of minimally invasive technological infrastructure. Only recently, ureterorenoscopy and LASER stone fragmentation are introduced. Open Surgery Ureteroscopy

3. Therapeutic Options available Until 2014 Laparoscopy • OPEN SURGERY Davancci Robot Roboflex Avicenna 2014 SWL • Ureteroscopy MET PCNL

4. Study Cases A case series of 6 large ureter stones 1-2 cm are treated through a modern approach and would have otherwise undergone open surgery. The underneath mentioned cases reflect the endourological approaches adopted even going back to OPEN SURGERY though abrasive and morbid.

5. Case One • Possible Options • MET • Open surgery • PCNL • Ureteroscopy • Laparoscopy • Robot Diagnosis Female, 36 Years L P U stone: 14 mm What would you opt for?

6. CaseTwo • Possible Options • MET • Open surgery • PCNL • Ureteroscopy • Laparoscopy • Robot Diagnosis Male, 54 years One right kidney Anuria R L U stone: 14 mm What would you opt for?

7. CaseThree • Possible Options • MET • Open surgery • PCNL • Ureteroscopy • Laparoscopy • Robot Diagnosis Female, 35 years L P U stone: 15 mm What would you opt for?

8. CaseFour • Possible Options • MET • Open surgery • PCNL • Ureteroscopy • Laparoscopy • Robot Diagnosis Male, 47 years R P U stone: 10 mm MET failed What would you opt for?

9. CaseFive • Possible Options • MET • Open surgery • PCNL • Ureteroscopy • Laparoscopy • Robot Diagnosis Male, 44 years L L U stone: 22 mm What would you opt for?

10. CaseSix • Possible Options • MET • Open surgery • PCNL • Ureteroscopy • Laparoscopy • Robot Diagnosis Female, 56 years R K stone : 20 mm What would you opt for?

11. EAU Recommendations Recommended treatment option (if indicated for active stone removal) (GR: A*) EAU Algorithm 2014

12. Indications for open surgery EAU Guidelines 2014

13. Fallouts Sometimes, though financial resources and technical platforms are available, the urologist is obliged to opt for a decision that does NOTlogically shadow theEAU Recommendations!!!

14. Case One URS scheduled. Spontaneous stone passage through MET after 3 weeks.

15. Case Two Semi-rigid ureteroscopy. Fragmentation with ballistic lithotripter. Post-OP JJ.

16. Case Three Semi-rigid ureteroscopy. Fragmentation with ballistic lithotripter. Post-OP JJ.

17. Cases Four &Five Fragmentation with semi-rigid ureteroscope LASER. Post-OP JJ. Case Five Case Four

18. Case Six The stone was found embedded in the ureteropelvic junction. Up to 50% of the stone was fragmented with flexible LASER. Cloudy urines observed. JJ placed. Treatment completed using delayed SWL.

19. Comments Though MET and Open Surgery are still practiced due to the restricted financial resources of patients as well as the availability and the limits of the technical platforms; URS is gaining ground slowly!

20. All in All What are the appropriate treatment choices to be recommended?

21. Conclusions • Open surgery has been the main if not the only treatment for stones in Algeria. Ureteroscopy has opened a path towards minimally invasive surgery in our country: • It has re-instated confidence in the use of conservative treatments as a first option. • Algeria has embarked towards a path to negligibly aggressive modern stone treatment. • The successful management of all aspects of stones treatment requires both competence and equipments. • The Algerian urologist is obliged to find the best solution to relieve his patients’ sufferings; nevertheless reality is rather problematic!