Treatment Options for Proximal Ureteral Urolithiasis: Review and Recommendations

Liong, Men Long; Clayman, Ralph V.; Gittes, Ruben F.; Lingeman, James E.; Huffman, Jeffry L.; Lyon, Edward S.

doi:10.1016/s0022-5347(17)40874-3

Cited by 122 publications

(61 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…6,7 The factors that negatively affect success rates include stone diameter >1 cm, hydronephrosis degree, and brand of SWL. 2,3 SWL is popular as a minimally invasive method that can be performed on an outpatient basis; however, severe complications, such as renal injury, subcapsular hematoma and renal scarring, are rare.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

Bozkurt

Yonguç

Arslan

et al. 2015

CUAJ

View full text Add to dashboard Cite

Introduction:The management of patients with large impacted upper ureteral stones is difficult; there is no standard treatment. We compared the outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (UL) to treat large (≥1.5 cm), impacted, upper ureteral stones. Methods: In total, 86 patients with large impacted upper ureteral stones were included in this study. Of these patients 41 underwent UL and 45 underwent PCNL. The inclusion criteria were: longest diameter of stone ≥1.5 cm, the localization of stone between the lower border of L4 spine and ureteropelvic junction and impacted stone. Results: In the UL group, we were unable to reach the stone in 3 patients because of ureteral stricture and edema despite balloon dilation. Of these 3 patients, we were unable to optimally visualize the stone in 2 patients due to bleeding and mucosal injury following balloon dilation. The stricture was too firm and could not be passed in the third patient. Also in the UL group, 15 patients had stones or big fragments which migrated into the renal collecting system. In the PCNL group, 21 patients had concurrent renal stones <1 cm and stones were successfully removed in all patients. No statistically significant difference was found between groups in terms of operation time. Mean hospital stay was significantly shorter in the UL group. Success rates were 82.3% in the UL group and 97.6% in the PCNL group (p = 0.001). Conclusion:The recent study confirms that PCNL is a safe and effective minimally invasive procedure with acceptable complication rates in the treatment of patients with large, impacted upper ureteral stones.

show abstract

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

Bozkurt

Yonguç

Arslan

et al. 2015

CUAJ

View full text Add to dashboard Cite

show abstract

“…Yapılan çalışmalarda 10 mm'den büyük proksimal üreter taşlarında ESWL'nin başarısı %56-96 olarak gösterilmiştir (6,7) . ESWL, uygun olgularda invaziv olmaması ve daha az komplikasyon oranı nedeniyle ilk seçenek olarak tercih edilebilir.…”

Section: Discussionunclassified

Comparison of flexible ureterorenoscopy and semi-rigid ureterorenoscopy effectiveness in the treatment of proximal ureteral stone

Cakir¹,

Polat²,

Bozkurt³

et al. 2017

Okmeydani Medical Journal

View full text Add to dashboard Cite

show abstract

“…The success of SWL on proximal ureteral stones varies between 57% and 96%. [5][6][7] Because SWL is less invasive than other approaches and is an outpatient method, both patients and doctors generally consider it a first-line therapy. SWL is not a surgical procedure and is therefore considered a non-invasive approach.…”

Section: Discussionmentioning

confidence: 99%

The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

Öztürk

Şener

Göktuğ

et al. 2013

CUAJ

View full text Add to dashboard Cite

Introduction: In this study we compare the success rates and complication rates of shock wave lithotripsy (SWL), laparoscopic, and ureteroscopic approaches for large (between 1 and 2 cm) proximal ureteral stones. Methods: In total, 151 patients with ureteral stones between 1 and 2 cm in diameter were randomized into 3 groups (52 SWL, 51 laparoscopy and 48 retrograde intrarenal surgery [RIRS]). The groups were compared for stone size, success rates, and complication rates using the modified Clavien grading system. Results: Stone burden of the groups were similar (p = 0.36). The success rates were 96%, 81% and 79%, respectively in the laparoscopy, SWL, and ureteroscopy groups. The success rate in laparoscopy group was significantly higher (p < 0.05). When these groups were compared for complication rates, RIRS seemed to be the group with the lowest complication rates (4.11%) (p < 0.05). SWL and laparoscopy seem to have similar rates of complication (7.06% and 7.86%, respectively, p = 0.12). Interpretation: To our knowledge, this is the first study to compare the results of laparoscopy, SWL and RIRS in ureteral stones. Our results showed that in management of patients with upper ureteral stones between 1 and 2 cm, laparoscopy is the most successful method based on its stone-free rates and acceptable complication rates. However, the limitations of our study are lack of hospital stay and cost-effectiveness data. Also, studies conducted on larger populations should support our findings. When a less invasive method is the only choice, SWL and flexible ureterorenoscopy methods have similar success rates. RIRS, however, has a lower complication rate than the other approaches. IntroductionUpper ureteral stones, which are hard to treat, are frequently encountered in daily practice. For treatment, the most effective and the safest approach should be chosen. Upper ureteral stones can be managed by various approaches. There is no gold standard treatment for stones between 1 and 2 cm. Even though some researchers recommend extracorporeal shock wave lithotripsy (SWL) as first-line treatment, 1 it has a 40% success rate in larger proximal ureteral calculi.2 With the common use of flexible devices in urology, ureteroscopy has gained popularity in the treatment of upper ureteral stones. For stones larger than 1 cm and fully obstructing the passage in the ureter, open or laparoscopic surgery may be an option with success rates up to 100%.1 In recent years, some authors have published their data on the laparoscopic approach and have recommended its use for its high success and low complication rates. 3This study compares the success and complication rates of SWL and laparoscopic and ureteroscopic approaches for proximal ureteral calculi between 1 and 2 cm. MethodsAfter Institutional Review Board approval, we enrolled 150 patients who had ureteral stones between 1 and 2 cm in the study; they were randomized into 3 groups by an online randomization program (52 for SWL, 51 for laparoscopy, and 48 for retrograde intrarenal surge...

show abstract

Treatment Options for Proximal Ureteral Urolithiasis: Review and Recommendations

Cited by 122 publications

References 3 publications

Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

Comparison of flexible ureterorenoscopy and semi-rigid ureterorenoscopy effectiveness in the treatment of proximal ureteral stone

The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

Contact Info

Product

Resources

About