Ureteral Stenting During Extracorporeal Shock Wave Lithotripsy: Help or Hindrance?

Preminger, Glenn M.; Kettelhut, Michael C.; Elkins, Sammie L.; Seger, JoAnn; Fetner, Christopher D.

doi:10.1016/s0022-5347(17)38654-8

Cited by 76 publications

(23 citation statements)

References 11 publications

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“…Furthermore, the presence of a stent results in a reduction of the shock wave energy reaching the stone and causes ureteral constriction and edema of the wall, both of which may reduce the chance of successful fragmentation or the passage of fragments after ESWL. 11 URS represents a safe and minimally invasive procedure in the management of ureteral stones. 7 Advancements in technology have made it a safe and highly successful procedure, reducing its complication rates.…”

Section: Commentmentioning

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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Section: Commentmentioning

confidence: 99%

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Osório

Lima

Soares

et al. 2007

Urology

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“…6,7 The utility of routine pre-procedural ureteral stent needs to be evaluated critically because the usage of stents has morbidity as well, as stenting is an invasive procedure increasing the chance of introducing infection into a noninfected system and the presence of stent itself leads of multitude of lower urinary tract irritative symptoms such as dysuria, frequency, hematuria, urgency. [8][9][10] Stents do have inherent risks of stent migration, vesicoureteral reflux and stent encrustation.…”

Section: Discussionmentioning

confidence: 99%

Prognostic implications of double J ureteral stenting in patients with renal stones undergoing extracorporeal shockwave lithotripsy

et al. 2017

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Background: Most patients with uncomplicated kidney stones can be successfully treated with extracorporeal shockwave lithotripsy (ESWL). Double-J ureteral stent is used to facilitate stone clearance, however double-J ureteral stents themselves may cause complications. Study conducted the study to know the exact role of double J stent in ESWL.Methods: 80 patients undergoing ESWL were divided into two groups, group A (n=40) double J stenting and group B (n=40) without double J stenting. Both groups were compared for stone fragmentation, stone clearance, number of shockwaves required for fragmentation, time required for passing through ureter, steinstrasse, Urinary Tract Infection.Results: Both the groups were comparable for age, sex, stone size and stone location distribution. There was no significant difference in clearance of stone and no. of shockwaves received for clearance in both the groups. The overall incidence of steinstrasse between the two groups was insignificant with a p value of 0.644. The incidence of UTI was significantly higher in stented group (p value 0.032).Conclusions: Study recommend ESWL without double J stent in patients having solitary renal calculus of size < 2 cm. Double J stent predisposes the patient to multiple complications including urinary tract infection which increases the morbidity of the patient. Based on our study we conclude that double J stenting in patients of renal calculus of size < 2cm, prior to ESWL is not beneficial.

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“…In the study by Sulaiman et al [3] of 1,087 patients, the incidence of SS was significantly lower in patients with stones 1 20 mm if a stent had been inserted prior to SWL. However, many other studies have shown that stents do not prevent SS [5] . On the other hand, most guidelines no longer suggest SWL for stones 1 2 cm in diameter [5] ; therefore, the incidence of SS should be reduced by the expanding use of percutaneous surgery.…”

Section: Introductionmentioning

confidence: 94%

“…However, many other studies have shown that stents do not prevent SS [5] . On the other hand, most guidelines no longer suggest SWL for stones 1 2 cm in diameter [5] ; therefore, the incidence of SS should be reduced by the expanding use of percutaneous surgery. Stents are associated with morbidity [6] and do not markedly improve the stone passage.…”

Section: Introductionmentioning

confidence: 94%

Does Ureteral Stenting prior to Shock Wave Lithotripsy Influence the Need for Intervention in Steinstrasse and Related Complications?

Ather

Shrestha

Mehmood³

2009

Urol Int

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Objective: To analyze factors affecting steinstrasse (SS) and study the impact of pre-shock wave lithotripsy (SWL) stenting in the prevention of SS and related complications. Patients and Methods: The cohort included 4,644 patients with renal stones treated by SWL. Three hundred and twenty-six (7%) developed SS. Initially, all patients were managed conservatively (group 1); interventions were reserved for those in whom conservative treatment failed (group 2). The 2 groups were further analyzed to identify factors influencing the need for intervention. The impact of pre-SWL stenting on the development of SS and the need for intervention was also assessed. Results: Expectant management was successful in 176 (54%) patients, while 150 (46%) required intervention for SS. The size of the stones had a significant association with the number of sessions required (p < 0.01) and the development of SS. The placement of a stent prior to SWL decreased neither the sessions of SWL (p < 0.01) nor the interventions required for SS and related complications. Conclusions: SWL for larger stones is a potentially significant complication of SWL and is associated with significant morbidity. Ureteral stents decrease the acute presentations of patients with SS; however, it does not decrease the ultimate need for intervention in the management of SS.

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Ureteral Stenting During Extracorporeal Shock Wave Lithotripsy: Help or Hindrance?

Cited by 76 publications

References 11 publications

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Emergency Ureteroscopic Management of Ureteral Stones: Why Not?

Prognostic implications of double J ureteral stenting in patients with renal stones undergoing extracorporeal shockwave lithotripsy

Does Ureteral Stenting prior to Shock Wave Lithotripsy Influence the Need for Intervention in Steinstrasse and Related Complications?

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