Treatment of Ureteral Stones: Comparison of Extracorporeal Shock Wave Lithotripsy and Endourologic Alternatives

Küpeli, Bora; Biri, Hasan; İsen, Kenan; Onaran, Metin; Alkibay, Turgut; Karaoğlan, Üstünol; Bozkırlı, İbrahim

doi:10.1159/000019786

Cited by 62 publications

(32 citation statements)

References 22 publications

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“…Impacted stones usually do not have a water-stone interface, which is important for fragmentation. Therefore, absorption or reflection of shock waves within the outer shell of the stone may be responsible for the lower success rare after SWL [8].…”

Section: Discussionmentioning

confidence: 99%

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: 99%

Retroperitoneoscopic Ureterolithotomy for the Treatment of Ureteral Calculi

et al. 2004

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“…Leblanc et al [5] reported 84% stone-free rate after URS in small distal ureteral stones, Peschel et al [4] reported 95% and Pardalidis et al [8] reported 90%, respectively (table 2). 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.…”

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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“…11 The consensus is that ESWL therapy should remain a first-line choice in upper ureteral stones, especially if it is less than 1 cm, keeping other modalities for unfragmented stones. 11,12 For distal ureteral calculi, ureteroscopy versus ESWL continues to be a topic of significant discussion. The success rate of ESWL for distal ureteral stones varies greatly in different reports, with stone-free rates from 53%-96%, and retreatment rates of 10-30%.…”

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 Ureteral Stones: Comparison of Extracorporeal Shock Wave Lithotripsy and Endourologic Alternatives

Cited by 62 publications

References 22 publications

Retroperitoneoscopic Ureterolithotomy for the Treatment of Ureteral Calculi

Retroperitoneoscopic Ureterolithotomy for the Treatment of Ureteral Calculi

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

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

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