Management and Follow-Up of Impacted Ureteral Stones

Abstract

Introduction: Impacted stones are those that remain unchanged in the same location for at least 2 months. Materials and Methods: We evaluated 42 patients with impacted ureteral stones, and followed them for two and a half years to check for long-term results. The calculi location included all three segments of the ureter (proximal, mid and distal). Patients’ age ranged from 22 to 83 years (mean 52.5 years). Primarily, patients were manipulated with extracorporeal shock wave lithotripsy (ESWL) in situ, or following stenting. If the result was not satisfactory, then we proceeded to retrograde ureteroscopy and ureterolithotripsy. Open ureterolithotomy was our final choice. Results: Thirty-six of the 42 patients (85.7%) were stone-free without the need of an open procedure. Follow-up period ranged from 10 up to 40 months, with a median period of 30 months and was achieved in 30 patients (71.4%). Stone recurrence was noted in 4 cases, while hydronephrosis without evidence of stone presence in 2. Conclusions: The initial approach for the treatment of impacted lithiasis should be attempted by ESWL. If this fails, alternative therapeutic solutions such as endoscopy can result in removal of the stone.

Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones

“…In the same series, spontaneous passage rate was also dependent on stone location (48% for stones in the proximal ureter, 60% for mid ureteral stones, 75% for distal stones, and 79% for ureterovesical junction stones). In addition to size and location, there are also other interfering factors such as obesity, level of renal obstruction and type of medical therapy (16). In our study, most of the stones and fragments that passed spontaneously were 7 mm or less and located in the lower ureter.…”

Evaluation of pneumatic versus holmium:YAG laser lithotripsy for impacted ureteral stones

“…Seven patients were excluded for several reasons, while 80 were included in the study. Inclusion criteria were patients with an impacted stone \20 mm located in the same position on two consecutive KUB for at least 1 month, nonvisualization of contrast medium beyond the stone on intravenous urography (IVU) or per-operative retrograde ureterography, and failure to pass guide wire by the side of the stone [1,2]. Exclusion criteria were patients on permanent anticoagulants, those with ureteral strictures, multiple stones, anatomical abnormalities, renal insufficiency, and a previously unsuccessful URS procedure.…”

“…Impacted stones are defined as calculi that have remained in the same position for at least 2 months [1], failure to pass a guide wire by the side of the stone, failure to visualize contrast medium beyond the stone [2]. Extracorporeal shockwave lithotripsy (SWL) is a non-invasive modality but the stone-free rate falls dramatically for impacted calculi [3,4] because of lack of natural expansion space around the stone [5,6].…”

Radiological non-invasive assessment of ureteral stone impaction into the ureteric wall: A critical evaluation with objective radiological parameters

“…impacted ureteral calculi constituted a clinical controversy for the practising urologists and the objective assessment of impaction for a well planned treatment of such stones is stil a matter of discussion [2,11,12]. Accumulated literature data have well demonstrated that the as the stone gets buried into the ureteric wall, this condition (often being called as "impaction") may affect not only the spontaneous passage rates; but also the ultimate success as well as procedure related complications of endourological stone removal methods [1,[12][13][14][15][16].…”