Introduction: Impacted stones are those that remain unchanged in the same location for at least 2 months. Materials and Methods: We evaluated 42 patients with impacted ureteral stones, and followed them for two and a half years to check for long-term results. The calculi location included all three segments of the ureter (proximal, mid and distal). Patients’ age ranged from 22 to 83 years (mean 52.5 years). Primarily, patients were manipulated with extracorporeal shock wave lithotripsy (ESWL) in situ, or following stenting. If the result was not satisfactory, then we proceeded to retrograde ureteroscopy and ureterolithotripsy. Open ureterolithotomy was our final choice. Results: Thirty-six of the 42 patients (85.7%) were stone-free without the need of an open procedure. Follow-up period ranged from 10 up to 40 months, with a median period of 30 months and was achieved in 30 patients (71.4%). Stone recurrence was noted in 4 cases, while hydronephrosis without evidence of stone presence in 2. Conclusions: The initial approach for the treatment of impacted lithiasis should be attempted by ESWL. If this fails, alternative therapeutic solutions such as endoscopy can result in removal of the stone.

Objective: It was the aim of this study to assess the efficacy and safety of combined forced hydration and diuresis with limited inversion during shock wave lithotripsy (SWL) by comparing this treatment modality with conventional SWL for lower calyceal nephrolithiasis. Patients and Methods: In this prospective, non-randomized study, we included 100 patients with lower calyceal calculi ≤2 cm. Fifty of them received conventional SWL and the other 50 underwent SWL combined with oral hydration, diuresis and 12° inversion position during SWL. Intravenous urography was performed for all patients prior to their treatment. Patients in both groups were treated on Dornier™ MPL 9000. Blood pressure monitoring was applied during the SWL session. Follow-up was performed the first and the third month after treatment with plain kidney-ureter-bladder X-ray and kidney-ureter-bladder ultrasound. Results: Clinical outcomes were available in 90 patients. Follow-up at 3 months showed that 83.3% of the patients belonging to the study group were rendered stone free, whereas 71.5% were stone free in the control (p > 0.05). Complications were minimal and not statistically significant. Conclusions: Forced diuresis and inversion therapy is very well tolerated; however, the stone-free rate was not significantly improved.

The treatment of urinary lithiasis has been revolutionized during the last three decades. Minimally invasive therapies in the form of endoscopic surgery in companion with the advent of shock wave lithotripsy have diminished the role of open stone surgery. Laparoscopy, another minimally invasive treatment, is continuously gaining place in the treatment of urinary stones, mainly replacing open surgery. We have tried to identify the level of the evidence and grade of recommendation, according to the evidence-based medicine criteria, in studies supporting the laparoscopic approach to stone extraction. The highest level of evidence (IIa) was found for laparoscopic ureterolithotomy. It is technically feasible with the advantage of being minimally invasive and having lower postoperative morbidity compared to open ureterolithotomy. It is mostly recommended (grade B) for large impacted stones or when endoscopic ureterolithotripsy or shock wave stone disintegration have failed. Laparoscopic pyelolithotomy is feasible but rarely indicated in the present era (III/B). Laparoscopic nephrolithotomy may be indicated to remove a stone from an anterior diverticulum or when PNL or flexible ureteroscopy have failed (III/B).