Ureteroscopic Treatment of Ureteral Stones: Only an Auxiliary Measure of Extracorporeal Shockwave Lithotripsy or a Primary Therapeutic Option?

Abstract

Both extracorporeal Shockwave lithotripsy (ESWL) and ureteroscopy are well-established methods in stone treatment; however, the therapeutic procedure in ureteral calculi, especially in the distal third of the ureter, is still controversially discussed. The aim of the present study was to examine the role of ureteroscopy as an auxiliary measure after ESWL and its importance as an alternative therapeutic option in the treatment of distal ureteral stones. Between 1991 and 1994, 115 ureteroscopic procedures in 104 patients with ureteral stones or stone fragments were carried out at our institution. During the same period of time, 1,595 patients with ureteral calculi (in the proximal two thirds of the ureter: n = 956; in the distal third of the ureter: n = 639) were treated with a Dornier HM-3 lithotriptor. In 77 of those 104 patients treated by ureteroscopy, this procedure was indicated as an auxiliary measure after failure of ESWL including 34 out of the 639 patients (5.3%) with stones in the distal part of the ureter. The overall direct success rate during the ureteroscopic stone treatment (including 11 cases with a second procedure) in the proximal, middle and distal third of the ureter was 74, 81 and 92%, respectively. The success rate of primary ureteroscopic removal of distal-third ureteral stones alone was 100% in 27 of these 104 patients. After 3 months the overall stone-free rate of all patients treated with ureteroscopy was 94%. Ureteroscopy appears to be a safe and effective treatment modality, if used as an auxiliary measure after failure of ESWL as well as a primary treatment modality in the case of stones in the distal third of the ureter. On the other hand, ESWL alone is a noninvasive and also successful procedure in treating stones situated in the distal part of the ureter.

Primary in situ extracorporeal shock wave lithotripsy in the management of ureteric calculi: results with a third‐generation lithotripter

“…ESWL has the obvious advantages of minimally invasive therapies, with no requirement for anaesthesia, treatment on an outpatient basis, a low morbidity rate [ 9, 10] and a high patient compliance (99% in the present study). If the patient accepts the re‐treatment rate and wishes to avoid a surgical procedure then ESWL would appear to be a reasonable first‐line treatment for stones in all locations within the ureter.…”

Comparison of Ureteroscopy (URS) Complementary Treatment after Extracorporeal Shock Wave Lithotripsy Failure with Primary URS Lithotripsy with Holmium Laser Treatment for Proximal Ureteral Stones Larger than 10mm

“…All these changes may cause more impacted stones. Severs studies have shown the phenomenon that the impacted stone rates are signi cantly higher after unsuccessful SWL [19][20][21], which may cause di culty and even more complications during URS. In our study, we also found that impacted stones and ureteral in ammation edema were seen predominantly in patients having already undergone SWL.…”

“…In previous studies, the success rates of URS with or without unsuccessful SWL were not statistically signi cant. The success rates of URS sessions after SWL failure ranged from 73.6%-78.9% [19][20][21]. In their researches, the stones were less than 10 mm in diameter.…”

Ureteroscopic Management of Ureteral Calculi: Pneumatic versus Holmium: YAG Laser Lithotripsy

“…Technical advancement in endoscope design and miniaturization have allowed surgeons to access calculi throughout the collecting system and regards as a gold standard for management of ureteral stones [1]. The stone free rates with the use of semi-rigid or flexible ureteroscopes have increased to 90% -100% for the distal ureteral calculi and to 74% for proximal ureteral calculi [2]. Moreover an impressive 95% of the patients were stone free rate after a single procedure [3].…”