Management of upper ureteral stones exceeding 15 mm in diameter: Shock wave lithotripsy versus semirigid ureteroscopy with holmium:yttrium–aluminum–garnet laser lithotripsy

Aboutaleb, Hamdy; Omar, Mohamed; Salem, Shady; El-Shazly, Medhat K.

doi:10.1177/2050312116685180

Cited by 18 publications

(24 citation statements)

References 31 publications

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“…For a mean stone size of 10-15 mm, the SFR ranged from 72.5 to 92% for SR-URS and from 58 to 78.6% for ESWL [12][13][14]. For stones ≥15 mm, Aboutaleb reported a 86 and 59% SFR after endoscopic lithotripsy and ESWL, respectively [4]. These results compare well with our findings of 81.8 and 91% SFRs for large proximal stones after a single and a second lithotripsy, respectively.…”

Section: Resultssupporting

confidence: 81%

“…Endoscopy of the upper tract only with the SR scope may be a challenging intervention, which fails in approximately 32% of patients. Mucosal edema, ureteral stenosis, steep angulation of the ureter, and a fixed urethra in males are some of the reasons of failure [4,6,7]. In such cases, f-URS may be used to approach and fragmentize centrally located stones [7,10].…”

Section: Resultsmentioning

confidence: 99%

“…The EAU guidelines acknowledge the merits of either the endoscopic procedures or the ESWL in the treatment of upper and lower ureteral stones with a size > 1 cm [3]. However, treatment with semirigid (SR) scopes may be less effective in proximally located larger ureteral stones [4,5]. The flexible instruments have enhanced our capability to approach all the ureteral stones, but there is still debate regarding the results in large proximally located ones [6][7][8][9], Herein, we present and discuss the results and complications of retrograde ureteroscopic (URS) treatment of large ureteral stones performed in the urologic department of a district Hospital in Magnesia.…”

Section: Introductionmentioning

confidence: 99%

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How Effective Is Retrograde Semirigid and Flexible Ureteroscopic Lithotripsy for the Treatment of Large Ureteral Stones Equal of or Greater than 15 mm? Results from a Single Center

Kozyrakis¹,

Kratiras²,

Perikleous³

et al. 2019

Urol Int

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Purpose: To present the results and complications of retrograde ureteroscopic lithotripsy for treatment of large ureteral stones. Methods: Nineteen patients were treated for ureteral stones ≥15 mm detected in CT or plain KUB film. Endoscopy was performed with either a semirigid or flexible ureteroscope. Stone fragmentation was performed using a 30 W Holmium laser. Results: The mean stone size was 20.7 mm (range 15–30). The mean duration of the operation was 82 min (45–140). Measures to prevent retropulsion of fragments into the kidney were not routinely applied. A subsequent RIRS during the same session was necessary in 2 cases. After a single procedure a stone free state was achieved in 15 cases (78.9%), while 4 others required a second session (ESWL or second ureterolithotripsy, 2 cases each). In only 1 patient, the stone-free state was not achieved after a 1.2 procedure per patient (overall success rate 94.7%). The mean duration of hospitalization was 1.9 days (range 1–5). Three patients experienced postoperative pyelonephritis and 2 others prolonged hematuria. Conclusion: Endoscopic lithotripsy is safe and effective in treating large ureteral stones. After a single endoscopic procedure, approximately 4 out of 5 patients are expected to become stone free. This rate increases to 95% with a second session of lithotripsy.

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Section: Resultssupporting

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How Effective Is Retrograde Semirigid and Flexible Ureteroscopic Lithotripsy for the Treatment of Large Ureteral Stones Equal of or Greater than 15 mm? Results from a Single Center

Kozyrakis¹,

Kratiras²,

Perikleous³

et al. 2019

Urol Int

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“…Aboutaleb et al concluded in his study that although SWL was shown to be safe for the removal ureteral stones, with a higher stone-free rate than URS, the complication rate is higher and hospital stay longer in patients who underwent SWL [15]. A comparison of URS and SWL in patients with proximal stones found no significant differences between these two modalities.…”

Section: Discussionmentioning

confidence: 98%

Comparison of Ureteroscopic Pneumatic Lithotripsy and Extracorporeal Shock Wave Lithotripsy for Proximal Ureteral Calculi

Rehman

Adnan

Hassan

et al. 2020

Cureus

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The goal of this study was to compare the effectiveness and complications of ureteroscopic pneumatic lithotripsy (URS) and extracorporeal shock wave lithotripsy (SWL) in the management of patients with proximal ureteral stones. Methods In this trial, 150 patients presenting with proximal ureteral stones at the Department of Urology of Nishter Hospital Multan from November 2018 to November 2019 were allocated 1:1 to undergo URS or SWL. The presence of stone fragments <4 mm on follow-up was regarded as being stone free. The study outcomes included stone-free rates after first, second, and third treatment sessions and stone retropulsion into the kidneys. Results A total of 75 patients each underwent URS and SWL. The mean procedure times for SWL and URS were 61.61± 3.21 and 85.01±6.75 minutes, respectively (P=0.000), and the mean numbers of procedures were 1.51±0.49 and 1.01±0.42, respectively (P=0.000). Stone-free rates after the first, second, and third sessions of SWL were 64%, 77.3%, and 94.7%, respectively, whereas stone-free rates after the first, second, and third sessions of URS were 86.7%, 92%, and 100%, respectively. Rates of stone retropulsion into the kidneys in the SWL and URS groups were 0% and 6.7%, respectively (P=0.000). Conclusion Compared with SWL, URS had significantly higher stone-free rates in patients with proximal ureteral stones. Treatment costs and hospital stay were lower in the SWL group, whereas complication rates were comparable.

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“…In this study, 10 cases were successfully directly transferred to ureteral flexible lithotripsy intraoperatively. Moreover, the holmium laser induces less damage to the ureter; when combined with ureteroscopy, it can make minimally invasive treatment more efficient and safer for urinary calculi [29]. Bagley et al [30] preferred to use flexible HLU for all upper ureteral stones.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for ureteroscopic lithotripsy: a case-control study and analysis of 385 cases of holmium laser ureterolithotripsy

Zheng

Wang

Bin

et al. 2020

wiitm

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Introduction: Ureteroscopic lithotripsy has become the first choice for the treatment of middle and lower ureteral stones, but it still has a certain rate of surgical failure. Here we aimed to determine the factors that may affect the success rate of holmium laser ureterolithotripsy (HLU) and provide the basis and guidance for its future use. Aim: To evaluate the risk factors for HLU failure. Material and methods: The clinical data of 385 patients undergoing holmium laser ureterolithotripsy from 2009 to 2012 were retrospectively reviewed to analyze the impact of gender, age, stone side, stone size, stone location, stone number, degree of hydronephrosis, stone impaction, previous extracorporeal shock lithotripsy (ESWL), and associated urinary tract infection (UTI) on the success or failure of surgery. Results: Surgical success was achieved in 338 (87.8%) patients versus surgical failure in 47 (12.2%) patients. Univariate analysis revealed that the degree of hydronephrosis (p = 0.024), stone impaction (p = 0.003), stone location (p = 0.012), and previous ESWL (p = 0.037) were risk factors for surgical failure. Multivariate logistic regression revealed that stone impaction (odds ratio (OR) = 2.66; p = 0.018) and stone location (OR = 2.11; p = 0.013) were significantly associated with surgical failure. Since some cases of ureterostenosis developed postoperatively, we continued follow-up. The patients had the stent for a year and underwent regular follow-up checks until 5 years. No cases of ureterostenosis recurred. Conclusions: Ureteroscopic lithotripsy is a safe procedure with few complications. Stone impaction and proximal location are the risk factors for its failure.

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Management of upper ureteral stones exceeding 15 mm in diameter: Shock wave lithotripsy versus semirigid ureteroscopy with holmium:yttrium–aluminum–garnet laser lithotripsy

Cited by 18 publications

References 31 publications

How Effective Is Retrograde Semirigid and Flexible Ureteroscopic Lithotripsy for the Treatment of Large Ureteral Stones Equal of or Greater than 15 mm? Results from a Single Center

How Effective Is Retrograde Semirigid and Flexible Ureteroscopic Lithotripsy for the Treatment of Large Ureteral Stones Equal of or Greater than 15 mm? Results from a Single Center

Comparison of Ureteroscopic Pneumatic Lithotripsy and Extracorporeal Shock Wave Lithotripsy for Proximal Ureteral Calculi

Risk factors for ureteroscopic lithotripsy: a case-control study and analysis of 385 cases of holmium laser ureterolithotripsy

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