2007 Guideline for the Management of Ureteral Calculi

Preminger, Glenn M.; Tiselius, Hans‐Göran; Assimos, Dean G.; Alken, P.; Buck, Colin; Gallucci, Michele; Knoll, Thomas; Lingeman, James E.; Nakada, Stephen Y.; Pearle, Margaret S.; Sarıca, Kemal; Türk, Christian; Wolf, J. Stuart

doi:10.1016/j.juro.2007.09.107

Cited by 732 publications

(495 citation statements)

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“…Due to its minimal invasion, safety and high curative effect, open surgery has been gradually replaced by ureteroscopic holmium laser lithotripsy 1 . Some reports show that extracorporeal shock wave lithotripsy (ESWL) has a higher stone clearance rate 2,3 . Nevertheless, stones shift to the renal pelvis in ureteroscopic holmium laser lithotripsy and lead to residual stones in some cases 4 …”

Section: Introductionmentioning

confidence: 99%

Comparative study on ureteroscopic lithotripsy and laparoscopic ureterolithotomy for treatment of unilateral upper ureteral stones

Fang

Qiu

Wang³

et al. 2012

Acta Cir. Bras.

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PURPOSE:To compare the curative effects of ureteroscopic lithotripsy and laparoscopic ureterolithotomy for unilateral upper ureteral stones, and to explore optimal surgical indications and skills. METHODS: Fifty cases of unilateral upper ureteral stones were randomly divided into two groups: one group underwent ureteroscopic holmium laser lithotripsy under epidural or lumbar anesthesia (n=25), and another group underwent laparoscopic ureterolithotomy under general anesthesia (n=25). Double-J stent was routinely indwelled in both groups. Operating time, postoperative hospitalization time, stone clearance rate and perioperative complications were compared. RESULTS: Operation was successfully performed in all 50 cases, and no open surgery was converted in any case. In the ureteroscopy and laparoscopy groups, the mean operating time was 49.0±10.7 min and 41.8±8.0 min (t=2.68, P=0.00999), respectively, their hospitalization time was 2.8±1.3 days vs. 2.9±0.8 days (t =-0.40, P=0.69413), and stone clearance rate was 88.0% (22/25) vs. 100% (25/25). Stone moved to the renal pelvis in three cases in the ureteroscopy group, and residual stones were removed by extracorporeal shock-wave lithotripsy (ESWL). All patients were followed up for more than three months, and no serious complications such as ureterostenosis occurred. CONCLUSIONS: Laparoscopic ureterolithotomy has a higher stone clearance rate and shorter operation time compared with ureteroscopic lithotripsy. Laparoscopic ureterolithotomy is one safe and effective treatment on unilateral upper ureteral stones. Key words: Ureteral Calculi. Ureteroscopy. Lithotripsy. Laparoscopy. RESUMO OBJETIVO:Comparar os efeitos curativos da litotripsia ureteroscópica e a ureterolitotomia laparoscópica para cálculos unilaterais altos e pesquisar as indicações e resultados. MÉTODOS: Cinquenta casos de cálculos unilaterais altos foram distribuídos aleatoriamente em dois grupos: um grupo submetido a litotripsia ureteroscópica com laser holmium sob anestesia epidural ou lombar (n=25) e outro grupo submetido a ureterolitotomia laparoscópica sob anestesia geral (n=25). Duplo-J stent foi rotineiramente instalado em ambos os grupos. Comparou-se o tempo operatório, tempo de hospitalização pós-operatória, nível de desaparecimento dos cálculos e complicações pós-operatórias. RESULTADOS: Atos operatórios nos 50 casos sem ocorrências e nenhum ato convertido. Nos grupos por ureteroscopia e laparoscopia, o tempo operatório médio foi 49,0±10,7 minutos e 41,8±8,0 minutos (t=2,68, P=0,00999) respectivamente, tempo de hospitalização foi 2,8±1,3 dias vs. 2,9±0,8 dias (t=0,40, P=0,69413) e o nível de desaparecimento dos cálculos foi 88.0% (22/25) vs. 100% (25/25). Cálculo deslocado para pelve renal em três casos no grupo ureteroscópico e cálculos residuais foram removidos por litotripsia por onda de choque extracorpóreo (ESWL). Todos pacientes foram seguidos por mais de três meses e não ocorreram complicações sérias como estenoses ureterais. CONCLUSÕES: A ureterolitotomia laparoscópica teve maio...

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Section: Introductionmentioning

confidence: 99%

Comparative study on ureteroscopic lithotripsy and laparoscopic ureterolithotomy for treatment of unilateral upper ureteral stones

Fang

Qiu

Wang³

et al. 2012

Acta Cir. Bras.

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“…As the intracorporeal portion of distance to the focal point increases, stone fragmentation and clearance is reduced. Other important drawback is that other variables that have been related to outcome, such as stone location and composition (9,10), and data obtained from a NCCT such as radiographic density measured in Hounsfield Units (HU) (11-13), anatomical findings and SSD (4,14) were not included in the analysis. A special consideration should be made regarding SSD, a test addresses the same issue as the Lithotripsy table height.…”

Section: Discussionmentioning

confidence: 99%

The lithotripsy table height: a novel predictor of outcome in shockwave lithotripsy

et al. 2011

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Background: Outcome of Extracorporeal Shockwave Lithotripsy (SWL) is determined by physical factors that affect stone fragmentation and clearance. Purpose: To evaluate the predictive value of the Lithotripsy Table Height (LTH) in SWL outcome. Lithotripsy Table Height (LTH) is a variable that represents skin to therapy head distance, and it is proportional to the energy that reaches the stone. Materials and Methods: A prospective study enrolled patients undergoing SWL for radiopaque urinary stones. All procedures were performed using a Modulith SLX (Karl Storz, Germany) Lithotripter. Patient weight, height and age; stone location and size; number of shock waves delivered, and LTH were recorded. One month post-procedure a KUB was obtained. Logistic regression analysis was used to evaluate the effects of these variables on stone-free outcome. A ROC curve was plotted. Results: Fifty-six patients were enrolled. After one month follow-up, overall success rate (Stone Free) was 83.9% (n = 47). LTH was the only independent predictor of outcome in both univariate and multivariate analysis (p = 0.029). Stone size (p = 0.45) and BMI (p = 0.32) were not significant. In the ROC curve, LTH showed an Area under the Curve = 0.791. Patients with LTH < 218 (n = 8) had relative risk of residual stones = 7.5, odds Ratio: 6.6 (Stone free rate 37.5% vs. 91.5%). Conclusion: LTH appears to be an independent predictor of SWL outcome. High success rates can be expected if LTH > 218. Patients with lower LTH had a less effective therapy, therefore, worse stone fragmentation and clearance. These findings may help improve patient selection for SWL therapy.

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“…(5) Both the AUA. (6) and the European Association of Urology (EAU). (7) recommend a-blockers for the treatment of ureteric stones.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study Comparing Tamsulosin and Silodosin in Medical Expulsive Therapy for Lower Ureteric Stones

Reddy¹,

Prathvi²,

Kulshreshtha³

et al. 2016

jemds

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The urinary stone disease is one of the most common afflictions of the modern society and it has been described since antiquity with the westernization of global culture. The efficacy of mini-invasive therapies, such as Extracorporeal Shock Wave Lithotripsy [ESWL] and ureteroscopy are not risk free, are problematic and are quite expensive. Recently, the use of watchful waiting approach has been extended by using Pharmacotherapy. This can reduce symptoms and facilitate stone expulsion. MATERIALS AND METHODSThis prospective randomised study was conducted between September 2015 and May 2016 at Rajarajeshwari Medical College and Hospital, Bangalore. The cohort comprised 100 adult patients (54 men and 46 women) who presented with a symptomatic, unilateral, single, uncomplicated lower ureteric stone of ≤ 10 mm. Patients were randomized into two equal groups, 50 (50%) patients received a daily single dose of tamsulosin 0.4 mg for 28 days and 50 (50%) patients received a daily single dose of silodosin 8 mg for 28 days. Both groups were compared in terms of patient's demographics, socioeconomic status, stone size and side, type of MET, stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use and incidence of side effects. Subgroup analysis was performed according to stone size ≤ or > 5 mm. RESULTSNo significant differences among the two groups for patient's age, gender, stone side and stone size. Spontaneous stone expulsion rate within 28 days was observed in 44 (88%) patients in the tamsulosin group and in 45 (90%) patients in the silodosin group without statistically significant differences. There were no statistically significant differences observed in terms of mean expulsion time, mean number of pain episodes and need for analgesics. Retrograde ejaculation was significantly higher in the silodosin arm, while the incidence of side effects related to peripheral vasodilation were higher in the tamsulosin arm, but it was statistically insignificant. CONCLUSIONTamsulosin and silodosin are equally effective as MET for distal ureteric stones sized 10 mm or smaller. MET with silodosin is associated with a lower incidence of side effects related to peripheral vasodilation, but a higher incidence of retrograde ejaculation when compared to tamsulosin. However, a multicentre study on a larger scale is needed to evaluate the current medicines. KEYWORDSTamsulosin, Silodosin, Stone Expulsion Rate, Medical Expulsion Therapy (MET). Financial or Other, Competing Interest: None. Submission 18-06-2016, Peer Review 13-07-2016, Acceptance 18-07-2016, Published 25-07-2016. Corresponding Author: Dr. Sreedhar Reddy, Professor and HOD, Department of Urology Raja Rajeshwari Medical College and Hospital, Bangalore. E-mail: urologyreddy@yahoo.com DOI: 10.14260/jemds/2016 Nevertheless these techniques are not risk free, are problematic and are quite expensive. (4) Recently, the use of watchful waiting approach has been extended by using Pharmacotherapy. This can reduce symptoms and facilitat...

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2007 Guideline for the Management of Ureteral Calculi

Cited by 732 publications

References 82 publications

Comparative study on ureteroscopic lithotripsy and laparoscopic ureterolithotomy for treatment of unilateral upper ureteral stones

Comparative study on ureteroscopic lithotripsy and laparoscopic ureterolithotomy for treatment of unilateral upper ureteral stones

The lithotripsy table height: a novel predictor of outcome in shockwave lithotripsy

A Prospective Study Comparing Tamsulosin and Silodosin in Medical Expulsive Therapy for Lower Ureteric Stones

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