A comparative analysis of nephrostomy, JJ stent and urgent <i>in situ</i> extracorporeal shock wave lithotripsy for obstructing ureteric stones

Joshi, H.B.; Obadeyi, O.O.; Rao, P. N.

doi:10.1046/j.1464-410x.1999.00174.x

Cited by 66 publications

(33 citation statements)

References 18 publications

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“…21 In our experience, we obtained a reasonable initial stone-free rate and an encouraging stone-free rate at 1 month. Thus, our patients had their problem solved in a relatively short period and with no need of additional bothersome auxiliary procedures, such as has been reported from other series in those undergoing emergency ESWL 5,6,10,22 (Table 2).…”

Section: Commentsupporting

confidence: 52%

“…Nevertheless, its potential disadvantages include leakage, dislodgement of the tube, and the need to manage the stoma. 10 Insertion of a double-J stent, apart from complications such as ureteral perforation and failure to pass the stent in some cases, may increase the risk of urosepsis. Furthermore, the presence of a stent results in a reduction of the shock wave energy reaching the stone and causes ureteral constriction and edema of the wall, both of which may reduce the chance of successful fragmentation or the passage of fragments after ESWL.…”

Section: Commentmentioning

confidence: 99%

“…Because of the lack of an ESWL machine at our center during the study period, we did not take into account this other attractive option, as recently suggested by some investigators. 5,6,10,20 Patients with complete obstructive ureteral stones, including a subgroup of 46 patients with proximal ureteral stones, were retrospectively divided into three groups by Joshi et al 10 A nephrostomy tube or double-J stent was placed to relieve obstruction with subsequent ESWL treatment. The remaining patients underwent urgent ESWL within 1 to 14 days without previous obstruction.…”

Section: Commentmentioning

confidence: 99%

“…Success after ESWL was significantly greater only compared with the percutaneous nephrostomy group, and no significant advantage was found when comparing stent positioning and subsequent ESWL. 10 The rationale for the use of rapid ESWL after a renal colic episode is to attain the maximal stone clearance in the shortest possible time. Doublet et al 20 found that immediate ESWL for obstructing ureteral stones is an effective treatment, giving results comparable to those of asymptomatic patients, with a 1-month stone-free rate of 94%.…”

Section: Commentmentioning

confidence: 99%

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Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Osório

Lima

Soares

et al. 2007

Urology

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OBJECTIVESTo describe a single-center experience in the emergency ureteroscopic management of ureteral stones. METHODSWe retrospectively considered the data from 144 patients (mean age 49.6 years, range 23 to 82) who had had obstructive ureteral stones and had undergone emergency ureteroscopy with stone retrieval. Intracorporeal pneumatic lithotripsy was performed when necessary. At the end of the procedure, a ureteral catheter was systematically left in place in 100 patients (69.4%) and removed within 24 hours. In the remaining 44 patients, a double-J stent was preferred and was removed within 30 days, depending on the clinical course. Stone-free status was defined as the complete absence of fragments at 1 month of follow-up. RESULTSThe calculi were more frequently localized in the distal ureter than in the proximal one (90.3% versus 9.7%, respectively). The overall mean stone diameter was 9.1 mm (range 5 to 20). The overall stone-free rate was 92.4%. A greater stone-free rate was obtained in those with stones less than 10 mm (95.8%) than in those with stones larger than 10 mm (89%, P ϭ 0.002). Similarly, a significantly better outcome occurred for those with stones located in the distal ureter (94.6%) than for those with stones in the proximal one (71.4%, P ϭ 0.004). The overall complication rate was 4.2%. The mean hospital stay was 2.5 days (range 1 to 7 R enal colic is often caused by ureteral stones, with most of them located in the distal ureter. 1 When conservative drug therapy does not resolve the symptoms, the placement of a ureteral catheter or nephrostomy tube represents the classic procedure performed for renal colic due to acute ureteral obstruction. These maneuvers can offer a prompt relief from pain for the patient, and they are usually followed by ureteroscopy (URS) or extracorporeal shockwave lithotripsy (ESWL), which currently represents the mainstay of treatment for ureteral stones. 2 Although URS is a more invasive treatment option than ESWL, the success rate of the latter is probably lower, especially for mid and distal ureteral stones. 3,4 To date, ESWL, as a first-line therapeutic option, applied rapidly after the onset of renal colic, has been given very limited attention. Only two randomized trials have been reported, both with encouraging results, even if most cases were of proximal ureteral stones. 5,6 Emergency ESWL is an attractive proposition, because it can result in both stone disintegration and relief from acute obstruction.Recently, the miniaturization of ureteroscopes, together with the introduction of the holmium laser, has improved stone-free rates and decreased the complication rates, widening the indications for URS. 7 Similar to ESWL, emergency URS can result in both stone disintegration and relief from colic pain. However, significant data on the ureteroscopic management of ureteral stones in an emergency setting are completely lacking.We describe our experience in the emergency ureteroscopic management of ureteral stones. The outcome, complications, and supposed advantag...

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Section: Commentsupporting

confidence: 52%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Osório

Lima

Soares

et al. 2007

Urology

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“…Others have used ESWL within 14 days of the onset of acute renal colic but under anesthesia (10) or even during acute renal colic (7) or acute renal failure (11). Moreover, a comparative retrospective analysis has shown that, in emergency situations, ESWL is more effective than nephrostomy or a double J stent and has very low morbidity (12).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones

2008

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�BSTR�CTPurpose: To assess the efficacy of extracorporeal shockwave lithotripsy (ESWL) for ureteral calculi during acute renal colic. Materials and Methods: From January 2002 to March 2007, 108 patients were treated by ESWL for obstructing ureteral stones causing acute renal colic. ESWL was performed within 24 hours of the onset of renal colic. Results: The mean age of the patients was 39.5 years (11-72 years). Male/female ratio was 85/23. Mean stone size was 8.45 mm (4-20 mm). They were located in the pelvic (n = 53), iliac (n = 28) or lumbar (n = 27) region. Fragmentation after a single session was complete in 56 patients (52%), incomplete in 28 (26%), and absent in 24 (22%). Patients presenting incomplete fragmentation underwent a second (n = 28) or even a third session (n = 11). Of the 24 patients in whom ESWL had no impact on the stone, 21 underwent ureteroscopy, and in one case open ureterolithotomy for a patient with a hard 17 mm stone, while spontaneous passage occurred in two patients with small stones. Conclusion: Emergency ESWL for obstructing ureteral stones has a satisfactory success rate and very low morbidity. The stone-free rate of retreating ureteral calculi with ESWL decreases significantly after failed initial treatment. Stone size may be the main predictive factor for retreatment. We suggest that no more than 3 treatments should be given for a particular stone due to minimal improvement in the subsequent cumulative treatment success rate.

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Management of Renal Colic and Triage in the Emergency Department

Conradie

2018

Smith's Textbook of Endourology

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A comparative analysis of nephrostomy, JJ stent and urgent in situ extracorporeal shock wave lithotripsy for obstructing ureteric stones

Cited by 66 publications

References 18 publications

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones

Management of Renal Colic and Triage in the Emergency Department

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