Management of Ureteric Stones

Marberger, Michael; Hofbauer, J.; Türk, Christian; Höbarth, K.; Albrecht, Walter

doi:10.1159/000475300

Cited by 74 publications

(34 citation statements)

References 32 publications

(45 reference statements)

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“…In patients with a previous endourological attempt which had failed, Goel and Hemal [15] reported that the retroperitoneoscopic removal of the ureteral stones is a viable alternative with an acceptable operation time (mean 108.8 min) for large upper and mid ureteric calculi. Therefore, ureteral stones of 11 cm and particularly in the upper ureter, chronically impacted stones and cystine or calcium-oxalate-monohydrate calculi are optimal candidates for RPU [2,16]. We performed RPU in patients in whom SWL had failed (71% in the present series) or large stones in the upper or mid ureter.…”

Section: Discussionmentioning

confidence: 90%

“…Most upper or middle ureteral stones are treated with shock wave lithotripsy (SWL), ureteroscopic lithotripsy (UL) or percutaneous lithotripsy (PL) [1,2]. Therefore open surgery is rare but may still be indicated in some cases due to failure of first-line treatment modalities or the characteristics of the stone (size, composition or location) [2].…”

Section: Introductionmentioning

confidence: 99%

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Retroperitoneoscopic Ureterolithotomy for the Treatment of Ureteral Calculi

et al. 2004

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Introduction: Most upper or middle ureteral stones are treated with shock wave lithotripsy or endoscopic techniques. In rare cases the ureteral stones are treated with open surgery after failure of first-line treatments. Retroperitoneoscopy is a minimally invasive alternative to open surgery. Patients and Methods: Between May 1995 and January 2001, twenty-one patients underwent retroperitoneoscopic ureterolithotomy. The stones in upper and middle ureter were large and impacted (5 patients) or not fragmented after shock wave lithotripsy (16 patients). A balloon dissector was placed and infiltrated with 800 ml air in the retroperitoneal space. Three 10-mm trocars were used. The pressure was kept at 15 mm Hg by carbon dioxide insufflation. The stones were extracted from the ureter using a laparoscopic stylet. Results: The stones in 17 patients were successfully removed in a median operating time of 105 (min–max 45–190) min. Urine extravasation in all cases and pnomoscrotum in 2 cases were observed as postoperative complications. The median hospital stay was 6 (min–max 3–22) days with minimal analgesic requirement. Conclusion: Retroperitoneoscopic ureterolithotomy is a useful and effective alternative treatment technique to open surgery when first-line treatments have failed or are unlikely to be effective.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Retroperitoneoscopic Ureterolithotomy for the Treatment of Ureteral Calculi

et al. 2004

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“…Advances in the design of the ureteroscope and ongoing development in ESWL have greatly impacted the management of ureteric stones (5). The indications for ureteroscopic lithotripsy have increased with smaller semi-rigid ureteroscopes and reliable laser technology and the production of more robust flexible instruments has further expanded the indications for endoscopic intervention.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

2006

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Objective: We compared the efficacy of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) for the treatment of distal ureteral calculi with respect to patient satisfaction. Materials and Methods: This is a prospective study where a total of 212 patients with solitary, radiopaque distal ureteral calculi were treated with ESWL (n = 92) using Dornier lithotriptor S (MedTech Europe GmbH) or URS (n = 120). Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. Results: The 2 groups were comparable in regard to patient age, sex, stone size, and side of treatment. The stone-free status for ESWL and URS at 3 months was 81.5% and 97.5%, respectively (p < 0.0001). In addition, 88% of patients who underwent ESWL versus 20% who underwent URS were discharged home the day of procedure. Minor complications occurred in 3.3% and 8.3% of the ESWL and URS groups, respectively (p = 0.127). No ureteral perforation or stricture occurred in the URS group. Postoperative flank pain and dysuria were more severe in the URS than ESWL group, although the differences were not statistically significant (p = 0.16). Patient satisfaction was high for both groups, including 94% for URS and 80% for ESWL (p = 0.002). Conclusions: URS is more effective than ESWL for the treatment of distal ureteral calculi. ESWL was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was significantly higher for URS according to the questionnaire used in this study.

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“…Kupeli et al [9] reported that ureteroscopic stone removal is more successful in distal ureter stones than SWL. According to Marberger et al [10], an in situ SWL attempt on larger stones in the distal ureter is worthwhile prior to any instrumentation. However, smaller stones seem to be the domain of primary URS as it is also reported by Ikemoto [11].…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Shockwave Lithotripsy Compared with Ureteroscopy for the Removal of Small Distal Ureteral Stones

Hautmann

Friedrich²,

Fernández³

et al. 2004

Urol Int

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Introduction: The treatment of small distal ureteral stones smaller or equal to 5 mm in size is still highly controversial. In distal ureteral stones larger than 5 mm in size, ureteroscopy (URS) has been shown in many studies to be superior to shockwave lithotripsy (SWL). The objective was to analyze the stone-free rate after treatment of distal ureteral stones with in situ SWL or URS. Materials and Methods: A total of 3,857 SWL treatments were performed at our institution between 1996 and 2001. During this period 45 in situ SWL procedures were performed with the Dornier MFL 5000 lithotripter on distal ureteral stones regardless of the stone size. A total of 262 URS treatments were performed on distal ureteral stones. URS for small (5 mm or less) distal ureteral stones was performed in 110 cases. Results: Distal ureteral stones smaller or equal to 5 mm in size were treated successfully stone free in 78% in one SWL session. Patients required a second SWL in 14% of the cases and 8% of the patients required a third SWL session. URS patients were successfully stone free after the procedure in 97% of the cases. Failed URS that needed an additional URS were performed in 2 and 1% of the patients had one SWL in situ treatment. Conclusions: URS treatment has shown to be the therapy of choice for distal ureteral stones. It is more effective than SWL treatment in this stone location. In experienced hands URS is a safe though even more invasive procedure than SWL. This can be expected as urologists perform more than 40 URS procedures per year.

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Management of Ureteric Stones

Cited by 74 publications

References 32 publications

Retroperitoneoscopic Ureterolithotomy for the Treatment of Ureteral Calculi

Retroperitoneoscopic Ureterolithotomy for the Treatment of Ureteral Calculi

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

Extracorporeal Shockwave Lithotripsy Compared with Ureteroscopy for the Removal of Small Distal Ureteral Stones

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