Treatment of ureteral stone disease: the role of ESWL and endourology

In this study we attempt to evaluate the advantages and disadvantages of extracorporeal shock wave lithotripsy (ESWL) in situ versus retrograde stone manipulation before ESWL (ESWL+push back) in patients with proximal ureteral stones with regard to tissue damage and inflammatory processes. Several studies have revealed that C-reactive protein (CRP) is a useful marker for tissue damage and inflammation. Thirty patients following primary ESWL in situ, with residual calculi, were randomized to retreatment with ESWL in situ or ESWL+push back. Four of 15 patients in the ESWL+push back group demonstrated an increase in CRP levels after treatment compared with no significant increase in 15 patients in the ESWL in situ group. We conclude that ESWL+push back did not cause significantly higher CRP values than ESWL in situ. ESWL+push back may cause irritation, inflammation, and slight tissue damage in some cases; however, these effects are probably minor and would not contraindicate its use. The implications of this study are that serum CRP levels may be utilized to monitor tissue injury in patients undergoing auxiliary procedures.

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein as a Marker for Tissue Damage in Patients Undergoing ESWL with or without Retrograde Stone Manipulation

Planz¹,

Wolff²,

Gutersohn³

et al. 1997

“…Whereas the success rate is high for stones situated in the kidney, the reported rate of success with ureteric stones has been variable [1][2][3] and the optimal treatment for stones in the mid-ureter (i.e. stones overlying the pel vic bone) is still controversial.…”

Section: Introductionmentioning

confidence: 99%

ESWL of Stones in the Mid-Ureter

Ruckdeschel¹,

Bauer²,

Schneider³

et al. 1992

Two hundred and twenty patients with a ureteric calculus were treated by in situ ESWL; in 60 of these the stone was located in the mid-ureter. Treatment was given without anesthesia or with sedoanalgesia only. Complete or partial stone clearance at the time of discharge from hospital was achieved in 95% irrespective of the site of the stone and there were no complications. It is suggested that in situ ESWL is effective in the treatment of stones in mid ureter as well as those in upper and lower ureter.

“…The treat ment has become increasingly noninvasive due to the introduction of percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS) [1]. More recently, extra corporeal shock-wave lithotripsy (ESWL) has been intro duced and has proved to be the preferred treatment of most upper urinary tract calculi in several centers [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Ureterorenoscopy in the Management of Renal and Ureteric Calculi

Olsen¹,

Pedersen²,

Wamberg³

et al. 1989

A total of 172 ureterorenoscopies were performed in 112 patients with 131 ureteric and renal calculi. The success rates for retrieval were 65, 59 and 79% in the upper, middle and lower third of the ureter, respectively. 32% of renal calculi were removed by ureterorenoscopy. By combined endourological techniques 89% of all stones were removed. Few complications occurred, and no late sequelae were recorded. It is concluded that ureterorenoscopic stone retrieval is an efficient and safe procedure, especially for lower ureteric stones. In the hand of a trained endourologist it might be attempted for upper ureteric calculi as well, and for certain renal stones in selected patients.