Сальважная экстракорпоральная ударно-волновая литотрипсия после неэффективной дистальной контактной лазерной литотрипсии

Abstract

Today, during the surgical intervention, it remains a problem that model of treatment of the stone of the distal ureter is optimal. Contact laser lithotripsy (CLL) has the advantage of extracorporeal shock wave lithotripsy (ECHL) as a method of choice in surgical treatment of distal ureteral stones. There are cases when CLL performed was ineffective, which required repeated fibro-ureteroscopy for extraction or lithotripsy of residual fragments of the stone. The objective: to evaluate the efficacy of salvage ECHL in patients after ineffective primary CLL. Patients and methods. From January 2007 to July 2017 in the Urology Clinic of the National Military Medical Clinical Center «GVCG» conducted 1756 EHCL with the help of the lithotripter Siemens Modularis Variostar. The results of treatment of 29 patients who underwent remote lithotripsy of the stones of the lower third of the ureter after ineffective CLL were retrospectively evaluated. Results. The average size of the stone in this group of patients was 7.3 mm. The average interval between CLL and ECHL was 14.1 days. The average number of strokes was 2712. All patients entered the ECHL session with the presence of a ureteral stent, which was installed immediately after the attempted CLL. In 24 (88.9%) patients, complete fragmentation of the stone was achieved after one ECHL session. Four other patients underwent additional surgical interventions. The conclusion. Contact laser lithotripsy (CLL) is an effective method of treating stones in the distal ureter. However, in case of inefficiency, it is necessary to consider the possibility of using salvage minimally invasive and traditional surgical interventions. Extracorporeal lithotripsy is just a minimally invasive method, has similar successful results compared to CLL. Salvage extracorporeal shock wave lithotripsy is an effective option in patients to whom the use of CLL has been unsuccessful.