Ureteroscopy and pneumatic lithotripsy, followed by extracorporeal shock wave lithotripsy for the treatment of distal ureteral stones

Abstract

Background : We retrospectively reviewed our experience with retrograde ureteroscopy (URS) and a pneumatic lithotriptor in 160 patients with distal ureteral stones to determine whether prior extracorporeal shock wave lithotripsy (ESWL) is a limiting factor in the ureteroscopic procedure. Methods : From January 1999 to September 2000, we performed URS and pneumatic lithotripsy in 160 patients with distal ureteral stones. Seventy-four patients were treated with URS primarily (Group 1), while the remaining 86 patients received URS only after ESWL had failed (Group 2). For URS and lithotripsy, we used a 9.5 French rigid instrument and vibrolith (Elmed, Ankara, Turkey).Results : In Group 1, 73 of 74 patients (98.6%) were treated successfully by URS alone, as were 81 of 86 patients (94.4%) in Group 2. Impacted stones were also observed in 17 patients from Group 2. In these patients, endoscopic observation revealed edematous inflammation above and below the calculus. Ureteral perforation occurred in one patient from Group 2, which required surgical repair. There was no significant difference in the stone-free rates of the two groups t = 1.4 < 1.96 t( ∞ ,0.05).Conclusion : Our data demonstrate that when ESWL fails, URS and pneumatic lithotripsy is as safe and effective as primary URS. Pneumatic lithotripsy also seems to be an effective treatment modality for impacted stones.

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

“…When active ureteral stone treatment is warranted, the best procedure to choose depends on several factors, including stone location and size, surgeon experience, patient preference, available equipment and cost effectiveness [10]. 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].…”

Clinical comparison of the pneumatic and the combined lithotripters in percutaneous nephrolithotomy

“…This mechanical energy is dissipated through the metal wire and acts as a chisel on the surface of the stone; therefore, direct contact with the stone surface is required, and heat is not generated throughout this action. An overall fragmentation rate of 84–100 per cent and stone‐free rate of 70–98.6 per cent have been reported . There are various probe sizes available, but they cannot be used with flexible instruments, which is considered a disadvantage.…”

“…An overall fragmentation rate of 84-100 per cent and stone-free rate of 70-98.6 per cent have been reported. 23,24 There are various probe sizes available, but they cannot be used with flexible instruments, which is considered a disadvantage. The inability to simultaneously extract stones during fragmentation, and retropulsion of the stone due to the energy released after contact with the stone, are other disadvantages.…”