Giant ureteral calculus

Two cases of giant ureteral calculus in young children are presented because of the large size of stones in this young age group.     

Current therapy of ureteral calculus

Since lithotripsy requiring no anesthesia recently became available, the discussion revolving around the treatment of choice for ureteral calculi has been renewed: is a preliminary retrograde manipulation still preferable for proximal calculi? Is ureteroscopy the better treatment for stones in the lower ureter? The retrospective evaluation of our patients with ureteral calculi (January to August 1988) failed to reveal a compromised efficiency with the modified HM3 Lithotripter (40 nF generator, 17 cm ellipsoid): 70% (including 11% with repeated sessions) of patients with proximal stones and 90% (including 28% with repeated sessions) of patients with distal calculi were successfully treated by in situ ESWL with no need for anesthesia, auxiliary measures, or ureteroscopy. These results do not significantly differ from those obtained with the old HM3, and they confirm that the majority of patients with ureteral calculi can bypass the discomfort of retrograde manipulation and the risks of ureteroscopy.     

Management of the impacted ureteral calculus

The management of 42 impacted ureteral calculi is reviewed. Impacted stones were defined by the inability to pass a guide wire or catheter on initial attempts. Stones were impacted in the upper ureter in 10 patients, mid ureter in 11 and lower ureter in 21. Upper ureteral stones were treated in 8 patients by extracorporeal shock wave lithotripsy after disimpaction by laser or other techniques. Mid ureteral stones were treated by laser alone in 7 patients and by extracorporeal shock wave lithotripsy after disimpaction in 4. Lower stones were treated by laser in 17 patients and ultrasound in 2. Complications included 3 major and 5 minor perforations, and 4 false passages. Treatment was successful without an open operation in 40 of 42 patients (95%). Our current approach to impacted ureteral calculi involves passing a rigid ureteroscope to the stone, with disimpaction performed by laser fragmentation or other dislodgement maneuvers. Proximal stones or large fragments then are treated by extracorporeal shock wave lithotripsy. Mid ureteral stones are treated similarly, unless they are so fragile that in situ fragmentation may be completed easily. Lower ureteral stones are fragmented in situ, with hard fragments extracted by basket. Alternative treatments for impacted calculi at all levels include unstented in situ extracorporeal shock wave lithotripsy, antegrade ureteroscopy and, finally, an operation.     

Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones

OBJECTIVE: To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. PATIENTS AND METHODS: From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. RESULTS: Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). CONCLUSION: Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.     

难治性输尿管结石的腔内分期治疗

目的 评估腔内分期治疗难治性输尿管结石安全性和临床疗效. 方法 腔内分期治疗难治性输尿管结石患者18例.男11例.女7例.年龄2～65岁,平均32岁.双侧结石2例.结石位于输尿管上段11侧、中段6侧、下段3侧.结石直径0.4～1.6 cm,平均0.9 cm.患者因输尿管扭曲、先天性狭细无法行输尿管镜下碎石取石或体外冲击波碎石失败而采取腔内分期治疗.18例第1次手术均被迫单纯留置输尿管内支架或经皮肾造瘘;第2次或第3次再行腔内治疗处理结石.结果 第1次手术后40～50 d行第2次手术,结石取净13例,第2次手术后50～60 d行第3次手术,结石取净5例.18例均无术中和术后并发症,18例取出内支架后随访6个月,未发现结石复发.结论 采取腔内分期治疗难治件输尿管结石安全可行.     

后腹腔镜输尿管上段复杂性结石切开取石术中结石移位的预防与处理

目的 探讨后腹腔镜输尿管上段复杂性结石切开取石术中结石移位的预防与处理。方法 回顾性分析13例复杂性输尿管上段结石行后腹腔镜输尿管切开取石术中结石移位患者的临床资料。结果 10例结石移位入肾盂,2例结石移位入肾上盏,1例移位入肾中盏。10例患者使用套石篮取石成功,3例患者使用输尿管软镜取出结石。结论 直接套石篮取石,必要时使用输尿管软镜可以有效处理后腹腔镜输尿管上段复杂性结石切开取石术中结石移位。
     

In situ dissolution of ureteral calculus.

An obstructing uric acid calculus was successfully managed by dissolution in situ. The methods used are described in detail. Perhaps not applicable in all cases, the ease of the procedure makes it worth considering especially in patients at high risk for open operative intervention.     

CT滚动图像诊断输尿管中、下段结石的价值

目的 探讨CT滚动图像在输尿管中、下段结石诊断中的价值.方法 回顾性分析2009年7月- -2011年12月在本院就诊螺旋CT平扫33例可疑输尿管中、下段结石患者,在CT显示器上通过滚动图像进一步诊断并通过输尿管镜验证.结果 33例患者均通过输尿管镜得到证实.结论 对于可疑输尿管中、下段结石,CT滚动图像对明确诊断具有重要意义.     

Hair as nidus for ureteral calculus formation: case report

A 52-year-old man with a significant history of nephrolithiasis was found to have a calcium oxalate dihydrate ureteral calculus that apparently formed on a hair. This nidus may have been introduced during previous instrumentation, perhaps on the tip of the ureteroscope, laser fiber, or even during the placement of a ureteral stent.     

Ureteroscopy for treatment of obstructing ureteral calculi in pregnant women: Single center experience

ObjectivesTo evaluate our experiences with ureteroscopic treatment of ureteral calculi in pregnancy.Patients and methodsBetween April 2006 and October 2013, 41 pregnant women with persistent renal colics and/or hematuria refractory to conservative measures were treated with ureteroscopy. The patients’ mean age was 23 (range 19–37) years. Most of the patients (56.1%) presented in the 2nd trimester.Loin pain and colic were the most common presenting symptoms (90.2%). Twenty-seven patients (65.9%) had an obstruction on the right side. All patients underwent ureteroscopy under epidural anesthesia.ResultsUreteroscopy revealed the presence of ureteric stones in 36 of the 41 cases. The stone size ranged from 5 to 16 (mean 8.9) mm. Distal ureteric stones were found in 29 patients. The pneumatic lithoclast was used for stone fragmentation in 22 of them (75.9%), while the stone was directly extracted in 4 patients. In 3 patients the stone migrated proximally and was not accessible any more. Proximal ureteric stones were detected in 7 of the remaining 12 cases. When attempting to manipulate these stones, they migrated more proximally and became unreachable. In the last 5 patients the entire ureter was free of stones; they only had edema at the ureteric orifice. A long lasting JJ stent was left until the end of the pregnancy in all cases with migrated inaccessible stones. In all patients successfully treated, a JJ stent with dangle extraction strings was left for two weeks. Minor urologic complications were encountered in the form of mild dysuria in 12 cases (29.2%) and mild hematuria in 5 cases (12.2%). All patients completed their pregnancy until full term without any serious obstetric complications requiring intervention.ConclusionUreteroscopy is a safe and effective therapeutic option for the treatment of obstructing ureteral stones in pregnancy with stone-free and complication rates comparable to the non-pregnant population.     

腹膜后腹腔镜治疗输尿管中上段结石的体会

目的:总结腹膜后腹腔镜手术治疗中上段输尿管结石的体会。方法:回顾分析2007年3月至2010年1月采用腹膜后腹腔镜手术治疗26例输尿管中上段结石患者的临床资料,结石直径1.0～2.0cm。结果:手术均获成功。手术时间60～160min,平均80min,术中出血30～120ml。结论:腹膜后腹腔镜手术治疗输尿管中上段结石简单易行,安全有效。