Endoscopic management of upper urinary tract stones

Abstract

Since 1981, 525 renal and ureteric calculi have been removed with percutaneous nephrolithotomy (PCN) or transurethral ureteroscopy as the primary modalities of therapy. Successful extraction of the stone at the first attempt was achieved in 92 per cent of cases by PCN and 70 per cent of cases by ureteroscopy, whilst further endoscopic surgery improved the overall success rates to 98 per cent and to 80 per cent respectively. Complication rates from these procedures have both been low as has the morbidity, with most patients leaving hospital within 4 days and returning to work within 2 weeks. The successful development of endoscopic lithotomy and the use of in situ destruction techniques has meant that we now reserve open surgery for difficult multibranched staghorn calculi and ureteric stones embedded in the urothelium. With the advent of extracorporeally generated shockwave lithotripsy it is likely that even these types of stone will be amenable to minimally invasive procedures.

Electrohydraulic and Ultrasonic Lithotripsy in 100 Consecutive Cases of Primary Ureteral Stones

“…At present, endoscopic lithotripsy of stones located in the lumbar ureter has been set aside in favor of ESWL, notwithstanding the excellent results obtained in our 20 cases treated percutaneously (90%), similar to the results obtained by other authors [11,22,28].…”

“…Experimental and clinical papers have also emerged regarding the in situ fragmentation of stones using electrohydraulic litho tripsy (EHL) [2,9,22,25,26,32] and ultrasonic litho tripsy (USL) [1,6,14,19,29], Given the scarce amount of publications in the litera ture comparing both techniques [8,10], we consider it interesting to present our experience with both types of lithotripsy.…”

Ureterorenoscopy in the Management of Renal and Ureteric Calculi

“…Our success rate of 32% by pri mary URS does not compare favorably with the success rate of 80-90% obtained by primary PCN L [1,8]. At this point it must be emphasized that ESWL has not been available in our country during this period.…”

“…Discussion URS has proved to be a valuable tool in the manage ment of upper urinary tract calculus disease. Success rates of more than 80% in large series have been reported [1,6,7], However, these reports comprise very few calculi in the upper part of the ureter, and the proce dure has been applied mainly for calculi in the mid and distal ureter [2,4], Our overall success rate for ureteric stones is 71 %, and 89% in the lower third of ureter. This is equal to the results of others and confirms that URS is a very efficient procedure especially in the lower part of the ureter.…”

“…The treat ment has become increasingly noninvasive due to the introduction of percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS) [1]. More recently, extra corporeal shock-wave lithotripsy (ESWL) has been intro duced and has proved to be the preferred treatment of most upper urinary tract calculi in several centers [2][3][4].…”