Ureteroscopic pneumatic lithotripsy of impacted ureteral calculi

Abstract

Introduction: This work evaluates the results of ureteroscopic treatment of impacted ureteral stones with a pneumatic lithotripter. Materials and Methods: From March 1997 to May 2002, 42 patients with impacted ureteral stones were treated by retrograde ureteroscopic pneumatic lithotripsy. Twenty-eight patients were female and 14 were male. The stone size ranged from 5 to 20 mm. The ureteral sites of the stones were distal in 21, middle in 12 and proximal in 9.Results: Considering stones with distal location in the ureter, 1 patient had ureteral perforation and developed a stricture in the follow-up (4.7%). As for stones in the middle ureter, 2 perforations and 1 stricture were observed (8.3%) and regarding stones located in the proximal ureter, 5 perforations and 4 strictures occurred (44%). In the mid ureter, 1 ureteral avulsion was verified. In 34 patients without ureteral perforation, only 1 developed a stricture (2.9%). Of 8 patients who had perforation, 6 developed strictures. The overall incidence of stricture following treatment of impacted ureteral calculi was 14.2%. Conclusions: Ureteroscopy for impacted ureteral calculi is associated with a higher incidence of ureteral perforation and stricture. Ureteroscopy of proximal ureteral calculi is associated with a high risk of perforation, when compared to mid or distal ureteral calculi. Ureteral perforation at the site of the stone seems to be the primary risk factor for stricture formation in these cases.

Is Bilateral Ureterorenoscopy the First Choice for the Treatment of Bilateral Ureteral Stones? An Updated Study

“…Although SWL is a reasonable first-line option for patients who are willing to accept a longer time to be stone-free or are unwilling to stay in the hospital to undergo general anesthesia, this technique is associated with high retreatment rates [11]. Some stones are difficult to fragment by SWL, and the fragments may remain in the urinary tract even after successful fragmentation of the stone [12]. SWL is efficacious for upper ureteral calculi with a diameter of less than 10 mm [13].…”

“…Beginning 14 months ago, we have been successfully using FURS and semirigid URS together with a Ho:YAG laser. An important point that should not be overlooked in the selection of PL is that pneumatic energy is stronger and cheaper than the holmium laser [12]. Comparing these two techniques will be the subject of a future study in our clinic.…”

Ureteroscopy Outcomes, Complications and Management of Perforations in Impacted Ureter Stones

“…Stone size and location are the most predictive factors for complication. Brito et al (14) reported that complication was not seen in situation with a stone size smaller than 5 mm, but complication was seen with stones larger than 5 mm, and complication rate was the highest in situations with stones larger than 10 mm. We have seen that the complication rate is 2 fold higher in stones larger than 10 mm than in smaller stones (53% vs. 26% p=0.01).…”

“…However, perforation increased the stricture rate about 14 fold in our study (5.6% vs. 80%). Brito et al (14) reported that perforation rate was 55% in impacted ureteral stones and stricture would be at a rate of 75% if perforation occurred. Permanent stricture occurred in four of five patients in whom the ureter was perforated and treated only by double-j stent, but stricture occurred in none of the three patients treated with open procedures in our study.…”

Influência do cálculo ureteral silencioso sobre a função renal antes e após o tratamento

“…As características dos cálculos tratados no estudo eram muito similares às dos pacientes com cálculo impactado em série histórica de nossa instituição [72] . Os cálculos eram em geral volumosos e radiopacos.…”