Randomized Trial of Stone Fragment Active Retrieval Versus Spontaneous Passage During Holmium Laser Lithotripsy for Ureteral Stones

Schatloff, Oscar; Lindner, Uri; Ramon, Jacob; Winkler, Harry

doi:10.1016/j.juro.2009.11.013

Cited by 66 publications

(29 citation statements)

References 16 publications

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“…Although PL can be used only with a semirigid ureterorenoscope, a laser can reach the entire urinary tract because it can be applied through both rigid and flexible devices. The procedure results in minimal ureteral trauma and postoperative edema with smaller residual fragments that are more likely to pass spontaneously [23]. Due to these technological advances, many changes have occurred in the traditional practice patterns, such as routine postoperative stenting and complete intraoperative fragment extraction.…”

Section: Discussionmentioning

confidence: 99%

“…The most serious complications of URS are ureteral perforation and stricture. These complications were less prevalent in recent reports, and almost all of the complications were treated with conservative approaches without causing further morbidity [2,21,22,23]. A unique and broadly accepted classification system can be helpful for monitoring and reporting outcomes in URS.…”

Section: Discussionmentioning

confidence: 99%

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Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications

et al. 2013

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Objective: To evaluate the complications of ureterorenoscopy (URS) using the modified Clavien classification system for ureteral stones with different localizations. Patients and Methods: From February 2001 to January 2010, a total of 1,926 patients underwent URS for the treatment of ureteral stones with different localizations. The complications were evaluated according to the modified Clavien system. Univariate and multivariate analyses were conducted to identify risk factors affecting the complication rates. Results: The patient cohort included 1,212 males and 714 females with a mean age of 47.8 ± 14.3 years (range 15-86). The success rate was 95.7%. The overall complication rate was 9.3%. Univariate analysis revealed that solitary kidney, stone burden, bilaterality, stone localization (proximal to the iliac crest) and stone impaction significantly affected the complication rates. Multivariate analysis revealed that preoperative shock wave lithotripsy treatment, stone impaction, multiplicity, proximal localization and stone burden were significant parameters affecting the occurrence of complications (relative risks of 6.5, 4.3, 3.3, 2.4 and 2.0, respectively). Conclusions: URS is a safe and minimally invasive procedure with a high success rate and low-grade, self-limiting complications. Preoperative shock wave lithotripsy treatment, stone impaction, multiplicity, proximal localization and stone burden were independent risk factors for the development of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications

et al. 2013

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“…A Ho:YAG laser can effectively fragment any stone regardless of composition or size and can reach the entire urinary tract because it can be deployed on rigid and flexible ureterorenoscopes [23]. Compared to other intracorporeal lithotripters, the holmium laser yields the smallest fragment size, with many fragments smaller than 1 mm [24].…”

Section: Discussionmentioning

confidence: 99%

Is Bilateral Ureterorenoscopy the First Choice for the Treatment of Bilateral Ureteral Stones? An Updated Study

et al. 2012

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Introduction: We analyze our recent results and discuss the advantages and disadvantages of bilateral single-session ureterorenoscopy (URS) for bilateral ureteral stones. Patients and Methods: 55 patients underwent URS with pneumatic lithotripsy (PL) for bilateral stones. 61 (55.5%), 28 (25.4%) and 21 (19.1%) stones were located in the lower, middle and upper ureter, respectively. Results: Of the 110 stones, 99 (90.0%) were fragmented in a single procedure. The stone clearance rate was 94.5% after the second session. The stone clearance rates with regard to stone location were 71.4, 89.3 and 96.7% for the upper, middle and lower ureter, respectively. An analysis of the clearance rates based on location demonstrated that lower ureteric stones were more successfully removed than upper ureteric stones (96.7 vs.71.4%, p = 0.003). Conclusion: Bilateral single-session URS with PL is a highly effective treatment modality for bilateral ureteral stones. The success rate of PL is affected by stone size and location.

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“…Bir grup ürolog taşların milimetrik boyuta gelmesi ile spontan düşüşünü tercih ederken, bir grup ürolog operasyon sırasında taştan tam temizlenmeyi tercih etmektedir. [4,9,10] Olgunun medikal ve sosyal durumu, hastanenin iş yükü, cerrahın tecrübesi gibi faktörlerle tercih edilen yöntemin deği-şebileceği düşüncesindeyiz. Grup 1'de üreter taşı pnömotik litotriptörle en büyük 1 mm olacak şekilde fragmante edilip işleme son verildi.…”

Section: Discussionunclassified

“…Grup 2'de ise 4 olgu 12-36. saatler arasında hafif kolik ağrı tarif etti ve bunların sadece ikisinin analjezik kullandığı öğrenildi. Schatloff ve ark., [10] kırılan üreter alt uç taş-larının spontan düşmeye bırakıldığı tedavi grubunda taş parçala-rının alındığı gruba göre acil servise başvurma, medikal desteğe ihtiyaç duyma oranını daha yüksek bulmuşlardır. Bu sonuç, çalışmamızla uyumludur.…”

Section: Discussionunclassified

Is it mandatory to use a guidewire and to collect the stone fragments in lower ureteral calculi?

Kalkan¹,

Uzun²,

Yalcinkaya³

et al. 2011

Turkish Journal of Urology

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Objective: This prospective clinical study compared two different ureteroscopic lithotripsy methods for treating lower ureteral stones. Materials and methods:Ureteroscopic lithotripsy was applied in 110 patients with lower ureteral stones between February 2007 and April 2011. The stones were fragmented with a pneumatic lithotripter. In Group 1 (n=55), ureteroscopic lithotripsy was performed without a guidewire and the stone fragments were not collected. In Group 2 (n=55), a ureteral guidewire was used and the stone fragments were collected with a basket catheter or forceps. The two groups were compared in terms of operating time, stone free rates, renal colic, and complications. Results:The mean operating time was 17 min (range 12-30 min) and 35 min (range 25-95 min) for Groups 1 and 2, respectively. Macroscopic hematuria was recorded in 3 patients in Group 1 for 30 hours compared to 8 patients for 48 hours in Group 2. Mild or moderate renal colic was observed in 9 patients in Group 1 and recurred 1-11 times versus only 4 cases in Group 2 (p<0.05). The patients were re-examined 20 days postoperatively, and no residual stone, urinary obstruction, hematuria or pain was observed in either group. Conclusion:For endoscopic treatment of lower ureteral stones, ureteroscopic lithotripsy without a guidewire and collection of the fragmented stones is safe for experienced urologists.

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Randomized Trial of Stone Fragment Active Retrieval Versus Spontaneous Passage During Holmium Laser Lithotripsy for Ureteral Stones

Cited by 66 publications

References 16 publications

Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications

Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications

Is Bilateral Ureterorenoscopy the First Choice for the Treatment of Bilateral Ureteral Stones? An Updated Study

Is it mandatory to use a guidewire and to collect the stone fragments in lower ureteral calculi?

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