Treatment of mid‐ and lower ureteric calculi: extracorporeal shock‐wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness

Bierkens, A.F.; Hendrikx, Ad J.M.; Rosette, J.J.M.H.C. de la; Stultiëns, G.N.; Beerlage, Harrie P.; Arends, Albert J.; Debruyne, F.M.J.

doi:10.1046/j.1464-410x.1998.00510.x

Cited by 135 publications

(80 citation statements)

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“…2 Although URS is a more invasive treatment option than ESWL, the success rate of the latter is probably lower, especially for mid and distal ureteral stones. 3,4 To date, ESWL, as a first-line therapeutic option, applied rapidly after the onset of renal colic, has been given very limited attention. Only two randomized trials have been reported, both with encouraging results, even if most cases were of proximal ureteral stones.…”

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confidence: 99%

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Osório

Lima

Soares

et al. 2007

Urology

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OBJECTIVESTo describe a single-center experience in the emergency ureteroscopic management of ureteral stones. METHODSWe retrospectively considered the data from 144 patients (mean age 49.6 years, range 23 to 82) who had had obstructive ureteral stones and had undergone emergency ureteroscopy with stone retrieval. Intracorporeal pneumatic lithotripsy was performed when necessary. At the end of the procedure, a ureteral catheter was systematically left in place in 100 patients (69.4%) and removed within 24 hours. In the remaining 44 patients, a double-J stent was preferred and was removed within 30 days, depending on the clinical course. Stone-free status was defined as the complete absence of fragments at 1 month of follow-up. RESULTSThe calculi were more frequently localized in the distal ureter than in the proximal one (90.3% versus 9.7%, respectively). The overall mean stone diameter was 9.1 mm (range 5 to 20). The overall stone-free rate was 92.4%. A greater stone-free rate was obtained in those with stones less than 10 mm (95.8%) than in those with stones larger than 10 mm (89%, P ϭ 0.002). Similarly, a significantly better outcome occurred for those with stones located in the distal ureter (94.6%) than for those with stones in the proximal one (71.4%, P ϭ 0.004). The overall complication rate was 4.2%. The mean hospital stay was 2.5 days (range 1 to 7 R enal colic is often caused by ureteral stones, with most of them located in the distal ureter. 1 When conservative drug therapy does not resolve the symptoms, the placement of a ureteral catheter or nephrostomy tube represents the classic procedure performed for renal colic due to acute ureteral obstruction. These maneuvers can offer a prompt relief from pain for the patient, and they are usually followed by ureteroscopy (URS) or extracorporeal shockwave lithotripsy (ESWL), which currently represents the mainstay of treatment for ureteral stones. 2 Although URS is a more invasive treatment option than ESWL, the success rate of the latter is probably lower, especially for mid and distal ureteral stones. 3,4 To date, ESWL, as a first-line therapeutic option, applied rapidly after the onset of renal colic, has been given very limited attention. Only two randomized trials have been reported, both with encouraging results, even if most cases were of proximal ureteral stones. 5,6 Emergency ESWL is an attractive proposition, because it can result in both stone disintegration and relief from acute obstruction.Recently, the miniaturization of ureteroscopes, together with the introduction of the holmium laser, has improved stone-free rates and decreased the complication rates, widening the indications for URS. 7 Similar to ESWL, emergency URS can result in both stone disintegration and relief from colic pain. However, significant data on the ureteroscopic management of ureteral stones in an emergency setting are completely lacking.We describe our experience in the emergency ureteroscopic management of ureteral stones. The outcome, complications, and supposed advantag...

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confidence: 99%

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Osório

Lima

Soares

et al. 2007

Urology

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“…Planning the research design, werelied on experimental and clinical facts, obtained earlier, notably: during the experiment the new electro pulse RCL method demonstrated high effectiveness in analogous sandcement mixture stone models destruction, including the samples consisting of 100% cement, during the singular pulse exposure with the power of 0.1 to 0.45 J [8,9]. Such pulse power is comparable with the power of pulses, generated by the most safe RCL types, the pneumatic and laser ones (0.1 -0.14 J and 0.12 -0.5 J, respectively) [1,4,6,7,10].…”

Section: Discussionmentioning

confidence: 99%

“…In 2006 the electro pulse method which was offered as a new way of contact lithotripsy, which looked like splitting up the nephrolith by the exposure of the solid body by the electro pulses of nanosecond duration [5]. The radical difference of the new lithotripsy method from the highly effective, but unsafe because of high pulse power, electrohydraulic RCL and remote lithotripsy (RL) [6,7], is exposure on the nephrolith surface, not on the fluid environment with the shockwave creation, affecting the stone. According to the experimental research data, carried out on the analogous nephrolith models, the change of solid body exposure pattern from mediated to direct allows to decrease power and number of electrical pulses, required for the effective lithotripsy, significantly [8].…”

Section: Introductionmentioning

confidence: 99%

The morphologic changes in the wall of the human urinary tracts after direct electro pulse exposure: the in vitro research

Gudkov¹,

Boshchenko²,

Недосеков³

2013

RusOMJ

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Abstract:The aim -study of the morphological changes in the wall of the human urinary tracts, developing after direct electro pulse exposure (DEPE). Materials and methods -The fragments of the surgical material obtained after the pelvis (n=25), ureter (n=33) and urinary bladder (n=20) open operations, were used in the research. DEPE was carried out by single (from 1 to 20) nanosecond pulses with the power of 0.8 J (joule) and 1.0 J made by the electro pulse "Urolit-105M" lithotriptor probe on the fragments' mucous tunic placed in the Petri dishes with 0.9% NaCl solution. The fragments were fixed in the formalin and after the processing, and pouring with paraffin, the tissue slices were prepared. Results -The kidney pelvis wall, where changes like epithelium desquamation, the basal membrane disorganization, paretic capillary expansion did not go beyond sub mucous layer even after exposure by 10 pulses with the power 1.0 J each, aimed at one point, proved to be the most resistant to DEPE. In the fragments of ureter and urinary bladder the same changes were detected after exposure by 5 pulses with the power of 1.0 J each, whereas after exposure by 10 pulses with the power 1.0 J each the changes occurred which were restricted by the muscular layer. Conclusion -The DEPEon the mucous tunic of the isolated urinary tracts fragments by the means of 10 pulses with the power of 1.0 J each looks safe, causes morphologic changes, restricted by the muscular layer and does not lead to the wall perforation.

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“…2 The choice of URS as a first-line therapy for distal ureteral calculi relies on the higher success rate, less fluoroscopy time and time to achieve a stone-free state. 2,4,13,14 Ureteroscopy is also less costly than ESWL for stones at all ureteral locations. 15 The high cost of purchasing and maintaining a lithotriptor is responsible for the high treatment cost associated with ESWL.…”

Section: Discussionmentioning

confidence: 99%

In Situ Extracorporeal Shock-Wave Lithotripsy as a Primary Treatment for Ureteral Stones

Maghraby

2003

Ann Saudi Med

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Background:The aim of the study was to evaluate the results of extracorporeal shock-wave lithotripsy (ESWL) as a primary treatment for ureteral calculi at different levels. Materials and Methods: We treated 166 consecutive patients with solitary ureteral stones (73 at the upper, 4 at the middle, and 89 at the lower ureter) by primary in situ ESWL on an outpatient basis. A maximum of three treatments were given individually before adopting ureteroscopy as an alternative treatment. The success rate was calculated on the basis of complete stone clearance and resolution of any associated obstruction. Re-treatment rates, complications and time to complete stone clearance were recorded. Results: Complete stone clearance was achieved in 152 patients (91.6%) after an average of 10.2 days (range 1-28). The average treatment rate was 1.3 sessions per patient. As whole groups, lower ureteral stones required more treatment sessions than those in the upper ureter, and the difference was statistically significant. However, the differences in the final success rate and time to stone clearance were statistically nonsignificant. When stratified according to size, the success rate was lowest for lower ureteral stones >1 cm in diameter. Conclusion:We believe ESWL is a safe and simple non-invasive option of choice for most ureteral calculi at different levels. Ureteroscopy represents an alternative choice in case of ESWL failure, or in cases of larger stones in the lower ureter when it might be the first option.

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Treatment of mid‐ and lower ureteric calculi: extracorporeal shock‐wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness

Cited by 135 publications

References 12 publications

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

The morphologic changes in the wall of the human urinary tracts after direct electro pulse exposure: the in vitro research

In Situ Extracorporeal Shock-Wave Lithotripsy as a Primary Treatment for Ureteral Stones

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