Comparison of Extracorporeal Shock Wave Lithotripsy and Ureteroscopy in the Treatment of Ureteral Calculi: A Prospective Study

Strohmaier, Walter; Schubert, G.; Rosenkranz, Thomas; Weigl, Armin

doi:10.1159/000020017

Cited by 84 publications

(59 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Osório

Lima

Soares

et al. 2007

Urology

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“…These results compare favorably with other reports even for stones in the lower ureter. [2][3][4][5] The clinical outcome of ESWL treatment of radiolucent stones did not appear to differ from that of radioopaque ones. Intravenous contrast medium administration overcomes the problem of reduced visibility by indirectly depicting the localization of the stone.…”

Section: Discussionmentioning

confidence: 82%

“…Such studies support proponents of ESWL as a first choice treatment of ureteral calculi regardless the location, while saving URS as a first choice for distal obstructive calculi and those with difficult radiological study. 3,5,8,16 Although stones in the upper ureter might respond better to ESWL treatment than those in the lower ureter, the ultimate treatment results are comparable in both clinical settings. At an institution where ESWL and URS are equally available, ESWL is still a valid safe and simple non-invasive option of choice for most ureteral calculi at different levels.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, other studies correlated treatment failure with ESWL voltage and stone composition, but not location or inadequate treatment. 3,8,9 A subgroup of calculi less likely to succeed could thus be identified: calculi >1 cm 2 , with severe uropathy and functional annulment or delay. The major disadvantages of ESWL are the number of repetitions often required, and the long wait until the last fragment is passed.…”

Section: Discussionmentioning

confidence: 99%

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In Situ Extracorporeal Shock-Wave Lithotripsy as a Primary Treatment for Ureteral Stones

Maghraby

2003

Ann Saudi Med

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Background:The aim of the study was to evaluate the results of extracorporeal shock-wave lithotripsy (ESWL) as a primary treatment for ureteral calculi at different levels. Materials and Methods: We treated 166 consecutive patients with solitary ureteral stones (73 at the upper, 4 at the middle, and 89 at the lower ureter) by primary in situ ESWL on an outpatient basis. A maximum of three treatments were given individually before adopting ureteroscopy as an alternative treatment. The success rate was calculated on the basis of complete stone clearance and resolution of any associated obstruction. Re-treatment rates, complications and time to complete stone clearance were recorded. Results: Complete stone clearance was achieved in 152 patients (91.6%) after an average of 10.2 days (range 1-28). The average treatment rate was 1.3 sessions per patient. As whole groups, lower ureteral stones required more treatment sessions than those in the upper ureter, and the difference was statistically significant. However, the differences in the final success rate and time to stone clearance were statistically nonsignificant. When stratified according to size, the success rate was lowest for lower ureteral stones >1 cm in diameter. Conclusion:We believe ESWL is a safe and simple non-invasive option of choice for most ureteral calculi at different levels. Ureteroscopy represents an alternative choice in case of ESWL failure, or in cases of larger stones in the lower ureter when it might be the first option.

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“…Bunun tersine ESWL'de taşın lokalizasyonu yukarı çıktıkça başarı oranı artmaktadır. [3][4][5] Her iki yöntemden birinin birincil tedavide başarısız olduğu durumlarda diğeri alternatif veya tamamlayıcı tedavi olarak başarıyla kullanılabilmektedir. Ayrıca ESWL sonrası taş yolu gelişimi gibi nedenlerle de ÜRS ihtiyacı doğabilmektedir.…”

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The need for additional equipment after ESWL in ureteroscopic lithotripsy

Guner¹,

Çaşkurlu²,

Karakose³

et al. 2011

Turkish Journal of Urology

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Objective: This study evaluated our results with ureteroscopic lithotripsy (URS) in patients with failed extracorporeal shock wave lithotripsy therapy (ESWL) and examined the effect of previous ESWL on the use of tools during URS, operating time, and outcome. Materials and methods:URS performed in two centers between 2008 and 2011 was reviewed retrospectively. The patients were divided into two groups according to the history of previous ESWL: 1) patients who underwent ESWL previously (n=39) and 2) no previous ESWL (n=116). Results:The demographic data were similar in both groups. The use of accessory tools and treatment failure was statistically higher in Group 1. The operating time was longer in Group 1. The need for re-operation, balloon dilatation, and ureteral catheter was similar in the two groups. However, the use of accessory equipment was increased by 56% in those with a previous ESWL. Balloon dilatation was required in 17.9% of the patients in Group 1. Conclusion:URS is the main treatment modality after the failure of ESWL. In patients with a history of ESWL, the need for accessory equipment is increased.Key words: Equipment; lithotripsy; treatment failure; ureteroscopy. ÖZETAmaç: Çalışmanın amacı vücut dışı şok dalga tedavisi (ESWL) başarısız olmuş hastalarda üreteroskopik litotripsi (ÜRS) sonuçlarımızı incelemek ve geçirilmiş ESWL öyküsünün ÜRS esnasında alet kullanımı, operasyon süresi ve başarı üzerine olan etkisini değerlendirmektir. Gereç ve yöntem:2008-2011 yılları arasında iki merkezde yapılan ÜRS vakaları retrospektif olarak değer-lendirildi ve geçirilmiş ESWL öyküsüne göre hastalar iki gruba ayrıldı. ESWL öyküsü olan 39 hasta Grup 1, ESWL öyküsü olmayan 116 hasta Grup 2 olarak tanımlandı. Bulgular:Her iki grubun demografik verileri benzerdi. Grup 1'de başarısızlık ve aksesuar alet kullanımı istatistiksel olarak daha yüksekti. Operasyon süresi Grup 1'de daha uzun olarak tespit edildi. Geçirilmiş ESWL öyküsü olanlarda yeniden operasyon, balon dilatasyon gereksinimi ve üreter kateteri gereksinimi ESWL öyküsü olmayan hastalarla benzerdi. Ancak geçirilmiş ESWL öyküsü olanlarda aksesuar alet kullanımı %56 oranında artmakta idi. Stone cone, en sık kullanılan aksesuar alet idi. Grup 1'deki hastaların %17.9'unda balon dilatasyon gereksinimi oldu.Sonuç: ESWL başarısızlığı sonrası ÜRS esas tedavi yöntemidir. Geçirilmiş ESWL öyküsü olanlarda aksesuar alet kullanım gereksinimi artmaktadır. Son üç dekatda üreteroskopi (ÜRS) ve dışa-rıdan şok dalga tedavisi (ESWL) cihazlarının gelişimiyle üreter ve böbrek taşı tedavisinde yeni bir çığır açılmıştır. Avrupa ve Amerika rehberlerinde yer alan bir tedavi seçeneği olarak ESWL, son yıllarda düşük morbidite ve yüksek başarı oranları ile üriner sistem taşları-nın tedavisinde yaygın olarak kullanılmaktadır.ESWL için kullanılan cihazlardaki teknolojik gelişime rağmen, halen hem taşların tamamı bu yöntemle kırılmadığı için hem de sistemin taşlardan tamamen temizlenebilmesi için ek cihaz ve girişimlere ihtiyaç duyulabilmektedır. Daha küçük çaplı ve daha geniş ça...

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Comparison of Extracorporeal Shock Wave Lithotripsy and Ureteroscopy in the Treatment of Ureteral Calculi: A Prospective Study

Cited by 84 publications

References 14 publications

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

In Situ Extracorporeal Shock-Wave Lithotripsy as a Primary Treatment for Ureteral Stones

The need for additional equipment after ESWL in ureteroscopic lithotripsy

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