Ureteral Stones Clinical Guidelines Panel Summary Report on the Management of Ureteral Calculi

Abstract

Most ureteral stones will pass spontaneously. Those that do not can be removed by either shock wave lithotripsy or ureteroscopy. Traditional blind basket extraction, without fluoroscopic control and guide wires, is not recommended. Open surgery is appropriate as a salvage procedure or in certain unusual circumstances.

Augmentation cystoplasty

“…Although asymptomatic bacteriuria with mixed organisms occurs in 50±100% of augmentation cystoplasties [18,32,43,46] the incidence of signi®cant UTI is reportedly lower (4±43%) [25,52,54]. In our experience, recurrent bacteriuria is found in >75% of patients and there was a 20% incidence of troublesome UTI.…”

“…Augmentation cystoplasty is reported to have a 0±2.7% mortality, with higher mortality rates reported in the earlier series and associated with additional procedures such as undiversion [32,42,43,46,49,50,98,99]. None of our 267 patients who have been followed-up for a minimum of 5 years (range 5±17) died after surgery.…”

“…IVU or renal ultrasonography of the upper urinary tract, and serum creatinine and radioisotope renal studies, provide information about total and differential renal function and the presence of upper tract obstruction [42]. Renal calculi, if present, are probably best treated before the augmentation procedure, as per routine practice [43,44]. The lower urinary tract is evaluated with ®lling and voiding video-urodynamics and cysto-urethroscopy.…”

Role of dilatation of intramural ureter in patients with lower urinary tract symptoms (LUTS) in UVJ and pre UVJ calculus: an observational study

“…This was similar to that found by Ordon et al 7 As most stones less than 5mm pass spontaneously relatively larger stones require intervention in the form of medical expulsive therapy or other modalities. 8,9 Shock wave lithotripsy (ESWL) and ureteroscopy are the treatment options for stones 1cm. or less in the distal ureter.…”

“…or less in the distal ureter. 9 Several studies have demonstrated the clinical efficacy of ESWL in fragmenting and clearing ureteric calculi. 10 Supporters of ESWL claim that it is effective and non-invasive, and can be done on an outpatient basis with intravenous sedation.…”