Extracorporeal shockwave lithotripsy of distal ureteral calculi

To date, the use of extracorporeal shockwave lithotripsy (ESWL) has been limited to renal calculi and ureteral calculi above the pelvic brim. Modifying the position of the patient on the support of the Dornier lithotripter HM3, we were able to localize and treat distal ureteral calculi. Until April 1986, 43 patients with stones in the lower ureter underwent contact-free lithotripsy. Treatment was successful in 39 patients (90%), 2 of these requiring 2 sessions. In 4 patients treatment failed and stone removal was accomplished using ureteroscopy or open surgery. No complications or adverse side effects were encountered in the whole series. ESWL is now the method of choice for the treatment of distal ureteral calculi in our department.     

Extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy for ureteral stones. A comparative study

From June 1987 to December 1988, 212 cases of ureteral calculi were treated with ESWL and ureteroscopic lithotripsy (URSL) respectively. The lithotriptic success rates of ESWL for upper, mid and distal ureteric stones were 100.0%, 100.0% and 93.4% respectively as compared with 62.5%, 85.7% and 93.7% of URSL. ESWL for upper and mid ureteral stones was obviously superior to URSL (P less than 0.001). The incidence rate of complications of ESWL was lower than that of URSL (P less than 0.05). In the 212 cases, urinary extravasation caused by ureteral injury occurred in 4 cases treated by URSL. We suggest that ESWL should be the first treatment of choice for ureteral calculi and URSL is not recommended for the treatment of upper ureteral calculi, but it may be used as an adjunctive method.     

Extracorporeal shockwave lithotripsy in the treatment of distal ureteral stones larger than 10 mm in diameter

Optimal treatment for distal ureteral stones remains controversial. During a period of 10 years, from December 1992 to December 2002, 103 distal ureteral stones larger than 10 mm in diameter were treated at our institution with extracorporeal shock wave lithotripsy (ESWL) using the Siemens Lithostar. Only 2 patients had a ureteral stent in place at the time of treatment. The overall stone-free rate was 98% with 1-12 session and 3-month stone-free rate was 95.1%. These data reveal that a high success rate was achieved in multisession ESWL. Therefore, ESWL is considered to be acceptable as first-line therapy for fragmentation of distal ureteral stones larger than 10 mm in diameter.     

Extracorporeal shockwave lithotripsy of the ureteral calculus--clinical results with local shockwave lithotripsy

Second generation local shockwave lithotripsy appliances (Lithostar) were used for the treatment of upper and lower ureteral stones in 199 patients, 145 of whom had upper ureteral stones. In 78 patients the calculi were pushed back and all but one disintegrated. In 33 patients a catheter was inserted past the stone, which resulted of primary disintegration in 66%. In 19 of 34 patients (56%) in whom the stones could not be moved, primary disintegration was achieved. Distal ureteral stones were present in 54 patients and these were treated successfully by ESWL alone in 83.3%. Auxiliary measures (total 10%) included ureteroscopy, percutaneous extraction and ureterolithotomy. The results are discussed under the aspects of 'in situ' versus 'push-and-smash' procedures.     

Optimal treatment for distal ureteral calculi: extracorporeal shockwave lithotripsy versus ureteroscopy

BACKGROUND: The optimal treatment for distal ureteral calculi remains controversial. We present data from our institution to compare the efficacy of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy with different lithotripsy modalities (URSL). METHODS: From January 1994 to September 1997, 954 distal ureteral calculi were treated at our institution using in situ SWL (Siemens Lithostar) in 524 patients and ureteroscopy (Wolf 8.0F instrument and Swiss Lithoclast) in 430 patients. Stone sizes and patient ages were similar in these two groups. RESULTS: In the SWL group, the 3-month stone-free rate was 87%, and the effectiveness quotient (EQ) was 68.7%. In the URSL group, there was a 96% stone-free rate with an EQ of 92.1%. The SWL treatment was more expensive than URSL. CONCLUSION: At our institution, ureteroscopy is more efficacious than SWL for the treatment of distal ureteral calculi. In selected patients who had stones >10 mm with evidence of impaction and severe colic pain, we strongly suggest that URSL is the best choice.     

Extracorporeal shock wave lithotripsy of proximal and distal ureteral stones

Extracorporeal shock wave lithotripsy (ESWL) was used for treatment of 105 patients with ureteral stones. There were 77 stones in the upper part of the ureter, i.e. above the pelvic brim, and 28 in the lower part, i.e. below the sacroiliac joint. Successful fragmentation was attained in 101 (96%). In 93% of the patients with stones in the upper ureter and in 100% with stones in the lower ureter the fragments were eliminated completely. In 87% of the patients with stones in the upper ureter, a ureteral catheter was introduced under local anesthesia but without fluoroscopic control. It was thereby possible to remove 30% of the stones from the ureter to the kidney. For the remaining stones, saline was infused through the catheter during ESWL. For patients with stones in the lower part of the ureter, a ureteral catheter was passed in 79% and saline infused during treatment. Whereas some form of anesthesia was used for treatment of all upper ureteral stones, 89% of the treatments for lower ureteral stones were performed without anesthesia. Auxiliary procedures after ESWL were limited to four ureteral catheter manipulations for distal stones. Four proximal stones which remained unaffected by ESWL had to be treated by open surgery (3 stones) or percutaneous surgery (1 stone). Of 82 ureteric stones treated in situ the success fragmentation rate was 95%. The average number of ESWL sessions was 1.04 for both proximal and distal ureteral stones.     

Salvage extracorporeal shockwave lithotripsy after failed distal ureteroscopy

BACKGROUND AND PURPOSE: When intervention is necessary, controversy remains as to the best treatment modality for stones of the distal ureter. In general, ureteroscopy is favored over extracorporeal shockwave lithotripsy (SWL) as the treatment of choice for distal ureteral stones. Although uncommon, ureteroscopy failures have traditionally necessitated repeat ureteroscopy to retrieve retained stone fragments. We evaluated the efficacy of salvage SWL for failed primary distal ureteroscopy in the community setting. PATIENTS AND METHODS: From December 1989 to December 2000, 6099 patients underwent SWL with the Dornier HM4 lithotripter at our institution. We retrospectively identified 31 patients who had undergone the SWL after a failed distal ureteroscopy. RESULTS: The average stone size in these patients was 9.4 mm, the average time interval from ureteroscopy to SWL was 17.2 days, and the average number of shockwaves delivered was 2386. All patients had had stents placed after ureteroscopy. Twenty-seven patients (87%) had resolution of their stone burden after one SWL session. The remaining four patients underwent additional procedures. CONCLUSIONS: Ureteroscopy is an effective modality for the treatment of distal ureteral stones. However, when unsuccessful, a salvage procedure may be necessary. Extracorporeal lithotripsy is a less invasive procedure with comparable success rates in the distal ureter. This report suggests that salvage SWL is an appropriate option for patients in whom distal ureteroscopic stone extraction fails.     

Primary ureteroscopy for distal-ureteral stones compared with ureteroscopy after failed extracorporeal lithotripsy

BACKGROUND AND PURPOSE: We reviewed our experiences with ureteroscopic pneumatic lithotripsy (URS-PL) for the treatment of distal-ureteral stones and investigated whether failed extracorporeal shockwave lithotripsy (SWL) is a limiting factor for the ureteroscopic procedure. PATIENTS AND METHODS: We retrospectively studied the medical records of 375 patients treated with URS-PL from January 1999 to September 2005 in our clinic. Of these patients, 213 were treated with URS-PL primarily (group 1), whereas the remaining 162 patients had undergone SWL unsuccessfully before URS-PL was performed (group 2). We used 9F or 9.5F rigid instruments and the Vibrolith (Elmed, Ankara, Turkey). RESULTS: In group 1, 206 patients (96.7%) were treated successfully with URS alone, as were 155 patients (95.6%) in group 2. Impacted stones were observed in 21 patients in group 1 (9.85%) and in 57 patients in group 2 (35.1%). The average operating time was 33.19 +/- 9.039 minutes in group 1 and 57.42 +/- 8.757 minutes in group 2. The stone-free rates of the two groups were significantly different on the first postoperative day, but this difference decreased to an insignificant level at the end of the first month. CONCLUSION: When SWL fails, URS-PL is as safe and effective as primary URS. Pneumatic lithotripsy also seems to be effective for impacted stones.     

Extracorporeal shockwave lithotripsy vs ureteroscopy as first‐line therapy for patients with single,distal ureteric stones: a prospective randomized study

Study Type – Therapy (RCT)
Level of Evidence 1b

OBJECTIVE

To compare extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) as first‐line treatments for patients with distal ureteric stones.

PATIENTS AND METHODS

In all, 273 patients with single, monolateral, radiopaque, distal ureteric stones of 0.5–1.5 cm were enrolled in a prospective randomized trial. Patients were randomized to undergo ESWL (137) or URS (136). The electromagnetic Modulith SLX lithotripter (Storz Medical, Switzerland) was used for ESWL and a semi‐rigid ureteroscope was used for URS. Patients in both groups were compared for overall stone‐free rates (SFRs), re‐treatment rates, need for auxiliary procedures and complication rates. A subgroup analysis was performed in both groups according to stone size of ≤1 cm and >1 cm.

RESULTS

Patients in the ESWL group achieved a 92.70% overall SFR with a 44.88% re‐treatment rate and an 11.02% auxiliary procedure rate. Complications occurred in 15.32% of patients treated with ESWL. Patients in the URS group achieved a 94.85% overall SFR with a re‐treatment rate of 7.75% and an auxiliary procedure rate of 18.60%. Complications occurred in 19.11% of patients treated with URS. In the ESWL group, the need for re‐treatments and for auxiliary procedures as well as the incidence of complications was significantly higher in patients with stones of >1 cm. In patients with stones of ≤1 cm treated with ESWL the need for re‐treatments and for auxiliary procedures as well as the incidence of complications was significantly lower than for those treated with URS.

CONCLUSION

In centres where both techniques are available, ESWL should be the preferred treatment for patients with single distal ureteric stones of ≤1 cm and URS should be reserved for patients with stones of >1 cm.     

Extracorporeal shock wave lithotripsy versus ureteroscopy for distal ureteral calculi: a prospective randomized study

PURPOSE: We performed a prospective randomized study to determine appropriate first line treatment for distal ureteral stones. MATERIAL AND METHODS: Between January 1996 and October 1997, 80 patients with distal ureteral stones (40 smaller than 5 mm. and 40 larger than 5 mm.) were randomized and treated with extracorporeal shock wave lithotripsy or ureteroscopy with a 9.5 or 6.5F semirigid ureteroscope. RESULTS: Ureteroscopy was significantly better in terms of operative time, fluoroscopy time and time to achieve a stone-free state. The smaller the stones, the greater the difference between the 2 treatment modalities. CONCLUSIONS: For distal ureteral stones we recommend ureteroscopy as first line treatment.     

Extracorporeal shock wave lithotripsy for ureteral stones and cystine stones]

We report our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral and cystine stones, which are known to be difficult to treat by this method. First, in order to determine the effectiveness of the ureteral catheter in the destruction of ureteral stones, we compared the clinical results of 121 patients treated without the catheter and 141 patients inserted with the catheter. There was no significant difference in the success rate between the two groups regardless of stone size, which indicates that the use of the ureteral catheter had no effect on the outcome of treatment. We then studied the clinical results of impacted ureteral stones which are especially difficult to destroy. Excretory urography was performed to non-invasively diagnose these stones, and those without visualization in the ureter below the stone were diagnosed as impacted stones and treated by ESWL without the ureteral catheter. Among the stones with a diameter of 1 to 2 cm, the success rate was significantly lower in impacted stones compared to non-impacted stone. These findings suggest that ESWL treatment without the ureteral catheter may be effective for ureteral stones with a diameter of less than 1 cm and non-impacted stones with a diameter of 1 to 2 cm, while combination therapy with other methods such as TUL may be better for other stones. We also performed ESWL on 6 patients with renal stones and 2 patients with ureteral stones which were cystine stones. Renal stones required an average 4.1 treatment with an average of 1,875 shocks per treatment, and ureteral stones required 1.5 treatment with an average of 1,833 shocks.(ABSTRACT TRUNCATED AT 250 WORDS)     

Extracorporeal shockwave lithotripsy in patients with distal ureteral calculi does not influence the prostate specific antigen value.

BACKGROUND AND PURPOSE: Distal ureteral calculi can be treated with extracorporeal shockwave lithotripsy (SWL) in situ, which has a high rate of success. As the prostate is in vicinity of this part of the ureter, it is possible that the shockwaves may pass through the prostate also. We evaluated the effect of SWL on the serum concentration of prostate specific antigen (PSA). PATIENTS AND METHODS: A total of 44 men with distal ureteral calculi located a maximum of 20 mm from the ureteral orifice and without any history of recent urinary tract infection, benign prostatic hyperplasia, or prostate cancer underwent SWL with the Dornier HM-4 lithotripter. Their serum PSA values were measured 5 minutes before SWL as well as 3 hours and 1, 7, and 30 days afterward. The differences of these PSA values were estimated. From a control group of 10 healthy donors, two consecutive PSA values were obtained 30 days apart. RESULTS: Of these patients, 93% (41/44) were stone free within 1 month according to plain radiographs and ultrasonography. No statistically significant difference was observed between the PSA concentration before and after treatment or between the patients who underwent SWL and the control group. CONCLUSION: Treatment of distal ureteral calculi with SWL does not affect the serum PSA concentration.     

Extracorporeal shockwave lithotripsy: treatment of choice in ureteral calculi

Extracorporeal shock wave lithotripsy represents the therapy of choice for reno-ureteral stone disease being resolutive in more than 85% of cases. This procedure can be successfully applied to ureteral stones providing appropriate preoperative cystoscopic manipulations and a correct positioning of the patient on the stretcher of the lithotripter. We hereby report our experience in 119 patients with ureteral lithiasis submitted to extracorporeal shock wave lithotripsy with a 98% success rate.     

中段输尿管结石的原位体外冲击波碎石

目的 报告电磁式体外冲击波原位治疗中段输尿管结石疗效。方法 患者５４例,结石直径为５－２０ｍｍ,平均１１ｍｍ。ＥＳＷＬ治疗时经侧腹部入路并采用工能量冲击技术。工作电压２－７档,发射次数每序列３０００－５０００次,治疗结果代入效率商公式测算。结果 碎石治疗３个月内无石率为９６％,复震率３０％,效率商７４％。     

Extracorporeal shock wave lithotripsy in situ treatment for ureteral stones

Three hundred and sixteen patients with ureteral stones were treated in situ (without retrograde stone manipulation) with and without stent bypass (DJ stent, ureteral catheter). Results were generally better with stent bypass, but only marginally so for stones larger than 10 mm in diameter. Regardless of whether or not the ureter was stented, lower ureteral stones were more difficult to fragment than upper ureteral stones and pre-sacral stones did not respond well to in situ treatment. We observed that evaluation of stone disintegration and fragment evacuation could only be properly assessed after approximately 3 weeks post-ESWL.     

Extracorporeal shockwave lithotripsy versus ureteroscopy for 5- to 10-mm stones in the proximal ureter: Prospective effectiveness patient-preference trial

BACKGROUND: To establish the best treatment modality in our hospitals for patients with proximal-ureteral calculi 5 to 10 mm, we compared the treatment outcome in those who underwent primary ureteroscopy (URS) with that in patients who underwent primary in-situ SWL. The primary endpoints were stone-free rates at 3 weeks and 3 months and the subjective patient experience. PATIENTS AND METHODS: The study was a prospective patient-preference trial. From September 2002 to May 2005, 80 patients were included, of whom 71 could be evaluated. Thirty-three patients were treated with SWL and 38 with semirigid or flexible URS. Stone status was evaluated with excretory urography or noncontrast helical CT. The bother score of urinary-tract symptoms was recorded on a visual analog scale. RESULTS: The stone-free rate at 3 weeks was 58% and 78% (P = 0.061) and at 3 months 88% and 89% (P = 1) for SWL and URS, respectively. The percentage of patients in need of analgesics was 30% and 49% (P = 0.118) at 3 weeks and 9% and 21% (P = 0.181) at 3 months for the SWL and the URS group, respectively. The bother score regarding dysuria, hematuria, and flank pain were statistically significant in favor of SWL. CONCLUSION: Ureteroscopy tends to make patients stone free faster, but SWL is preferred by most patients because there is less discomfort after treatment.