Extracorporeal shock wave lithotripsy monotherapy for treatment of patients with urethral and bladder stones presenting with acute urinary retention

Abstract

ObjectivesTo present our experience with extracorporeal shock wave lithotripsy (ESWL) monotherapy for the treatment of patients with urethral and bladder stones presenting with acute urinary retention. MethodsA total of 64 patients (62 male and 2 female) with urethral or bladder stones underwent ESWL monotherapy. All patients presented to the emergency department with acute urinary retention. The mean patient age was 40 ± 13.2 years (range 11 to 74). The exclusion criteria were urethral strictures, associated bladder growths detected by pelvic ultrasonography, and bladder stones larger than 25 mm in the largest diameter. After fixation of a Foley catheter, ESWL monotherapy was performed with a Storz SL 20 lithotriptor. The catheter was removed after confirmation of stone fragmentation. ResultsFine fragmentation was obtained and uncomplicated spontaneous evacuation occurred without the need for adjuvant procedures in 60 patients. Four patients developed acute urinary retention due to urethral stone impaction. In 3 patients, the urethral catheter was successfully refixed, and an additional session of ESWL resulted in fine fragmentation of the stones, with spontaneous evacuation after catheter removal. In the remaining patient, the stone could not be pushed into the bladder and crushing was performed endoscopically. ConclusionsESWL monotherapy is safe and effective for the treatment of urethral and bladder stones in patients with no other causes of infravesical obstruction.