Extracorporeal Shock Wave Lithotripsy in the Treatment of Ureteric Stones: Experience from Tawam Hospital, United Arab Emirates

Abstract

Background:The optimal treatment of ureteric stones, especially the lower ureteric stone, remains controversial. The purpose of this study was to evaluate the role of extracorporeal shock wave lithotripsy (ESWL) in the management of ureteric stones. Materials and Methods: A total of 99 patients with ureteric stones at different levels were treated with ESWL from 1994 through 1998 at our hospital. All patients were treated using Siemen Lithostar-II Plus Lithotripter. Of the 99 patients, 20 were excluded from the study because they had no follow-up records of their stone-free status. The clearance rates for ureteric stones of the other 79 patients treated were stratified according to the site, size, and number of treatment sessions required per stone. The stone size was determined by the widest diameters. Based on stone size, the patients were divided into two groups: A (≤10 mm) and B (11-20 mm). Results: The overall clearance rate for ureteric stones treated with ESWL, irrespective of its site and size, was 78.5%. The overall clearance rate for size A (≤10 mm) stones was 82% and size B (11-20 mm) was 58% regardless of the site of the stone in the ureter. A total of 17 upper ureteric stones were treated with ESWL. The overall clearance rate for upper ureteric stones was 94%. Thirteen patients with mid-ureteric stones were treated with ESWL. The overall clearance rate for the mid-ureteric stones was 92.3%. Forty-nine patients had lower ureteric stones. The overall clearance rate for the lower ureteric stones was 69.3%. Conclusions: ESWL is safe, effective, noninvasive and a convenient way of treatment for all ureteric stones. The clearance rate for stones in the upper and mid-ureter is above 90%. ESWL being an outpatient procedure without any need for anesthesia or any pretreatment intervention, it should be considered as the first line of treatment for all stones in the upper and mid-ureter. The clearance rate for small stones (≤10mm) in the lower third of the ureter was 73.8% in our study and for these, ESWL may be considered as a primary therapy. For stones larger than 10 mm in the distal third of ureter, the clearance rate was low with a high retreatment rate, and ureteroscopy as primary treatment modality would be more preferable. Ann Saudi Med 2002,-22(1-2) The current management of upper urinary tract calculi is based on stone fragmentation into smaller pieces which are allowed to pass spontaneously, or removed with an endoscope. To achieve this, energy should be transferred to the stone either percutaneously (extracorporeal shock wave lithotripsy) or through an endoscope (intracoporeal lithotripsy). Chaussy et al. in 1980 was the first to report the clinical application of shock wave lithotripsy in the management of kidney stones, and since then the management of nephrolithiasis has undergone a complete revolution.1 Recent technological developments have resulted in more advanced lithotripters with shorter focal length and more narrow focal breadth, which help reduce the level of pain and ultimately obviate...

Extracorporeal Shock Wave Lithotripsy in the Treatment of Single Ureteric Stone. Initial Data from Iraq

“…In our study, the treatment of ureteral stones using ESWL were delayed for 2 -4 weeks after the diagnosis. Same was followed by other studies [3] [13] [16].…”

“…These waves cause stone fragmentation directly by producing mechanical stress or indirectly by collapsing of cavitation bubbles formed by the negative pressure in their trail. The initial result of ESWL was promising, with a greater than 90% success rate achieved [1] [2] After ESWL introduction in 1980s, the technological developments have resulted in more advanced lithotripters with shorter focal length and narrower focal breadth, which help reduce the level of pain and ultimately obviate the need for anaesthesia and hospital admission for the procedure [3].…”

Efficacy of extracorporeal shockwave lithotripsy using Dornier SII in different levels of ureteral stones

“…This result is comparable with those reported by other studies. Ghafoor and Halim[16] treated 17 upper ureteric stones with ESWL. The overall clearance rate for upper ureteric stones was 94%.…”

Outcome of Pushback Stenting and ESWL Versus in Situ ESWL for Upper Ureteric Stone -A Comparative Study

“…The management of urinary calculi was revolutionized by the introduction of extracorporeal shockwave lithotripsy (ESWL) in 1980 and the first successful ESWL treatment was accomplished in Germany by Dr. Christian Chaussy using a Dornier HM1 lithotripter. ESWL is a safe, effective and non-invasive method 2 . Even with the innovation and refinement of current endourologial methods for stone removal, ESWL remains the primary treatment option for most patients with uncomplicated upper urinary tract calculi 3,4,7,8,9 .…”

“…Steinstrasse refers to the column of stone fragments that can develop within the ureter which can be seen on plain abdominal radiography after ESWL. It may resolve spontaneously without producing any symptoms or may persist and cause loin pain, ureteral obstruction and urinary tract infection 14,15 . Success rates and complications are determined by the size, location and composition of the stone in the urinary tract, the type of lithotripter, shock wave energy and rate, and anatomical characteristics 12 .…”