CLINICAL STUDIES ON THE SURGICAL TREATMENT OF UROLITHIASIS

Abstract

The results and characteristics of 606 cases of urolithiasis treated from July 1982 to February 1989 at Gunma University Hospital and Jomo Urological Hospital were compared and a new treatment policy for urolithiasis was determined. Sixty patients were treated with open surgery, 30 with percutaneous nephroureterolithotomy (PNL), 317 with extracorporeal shock wave lithotripsy (ESWL) for renal and upper ureteral calculi, 74 with transurethral ureterolithotomy (TUL), 93 with ESWL for mid and lower ureteral calculi, 16 with stenting ESWL and 16 with combined PNL-ESWL therapy for large calculi. For each treatment, we studied removal rates of calculi, postoperative hospital stay, minor complications, trauma to the collecting system, renal parenchymal damage and the simplicity of reoperation. ESWL was first and TUL second in cost-benefit ratio as represented by removal rates of calculi and postoperative hospital stay. ESWL was the best and TUL ranked second in patient's accessibility to operation as represented by postoperative hospital stay, minor complications and trauma to the collecting system. ESWL was the best, followed by TUL, pyelolithotomy and ureterolithotomy in the extent of invasion of the urinary tract of the patient as represented by trauma to the collecting system and renal parenchymal damage. ESWL was the best and TUL second in doctor's accessibility to operation as represented by renal parenchymal damage, simplicity of reoperation and removal rates of calculi. We concluded that ESWL followed by TUL was the best procedure and that removal of urinary tract calculi should be performed mainly by ESWL, with consideration given to combination with other treatments. The choice of treatment depends on the diameter of the calculi. For upper ureteral and renal calculi with a maximum diameter of less than 20mm, ESWL alone is recommended as the first choice. For upper ureteral and renal calculi that are small in volume and have a maximum diameter greater than 20mm, stenting ESWL is the first choice. For large volume calculi, PNL-ESWL combination therapy preceded by PNL is the method of choice. For mid and lower ureteral calculi, ESWL including lifting with a ureteral catheter is the method of choice, and in case of failure, TUL or ESWL preceded by lifting with TUL should be performed.