Ureteral stone extraction under direct ureteroscopic vision: An alternative for routine ureteral stone management

Clinical Trials of the Surgical Management of Urolithiasis: Current Status and Future Needs

Through the introduction of ureterorenoscopy (URS) and extracorporal shock wave lithotripsy (ESWL) into stone treatment, the Zeiss-loop procedure has lost more and more its importance. Current guidelines recommend on the level of an expert-opinion, that stone extraction without endoscopic-visual control should not be performed anymore. Nevertheless, stone extraction using the Zeiss-loop is still being performed in our clinic and therefore we wanted to determine its position in stone treatment in the age of URS and ESWL. The data of 253 patients with ureter stones, who were treated with the Zeiss-loop were evaluated. The loop is always pulled through completely under radiological control. In 221 cases, the concrement was located in the distal ureter. All concrements have been maximally 10 mm in size. Independently of size and position, in 219 patients the loop extraction resulted in a complete stone removal. Complication rates are low. No complete tear-off of the ureter occurred. The overall success rates of loop extraction were superior to those of ESWL in ureter stones but worse than URS. Referring to distal stones, success rates are similar, but stones treated by URS have been bigger. Therefore, in our opinion, immediate stone extraction under fluoroscopic control with the Zeiss-loop, is still a possible treatment alternative for small distal stones (<10 mm). Being aware of these first "new" data of an old procedure, the Zeiss-loop will still play a role in endoscopic stone treatment in our department and should not be completely abandoned due to its bad reputation.

Clinical experience with shock-wave lithotripsy using the Siemens Modularis Vario lithotripter

Ho:YAG laser versus pneumatic lithotripsy for management of pediatric ureteral stones: a prospective–comparative analysis with adults

Semi-rigid ureteroscopy for ureteric and renal pelvic calculi: Predictive factors for complications and success

Prospective Randomized Evaluation of Emergency Extracorporeal Shock Wave Lithotripsy (ESWL) on the Short-Time Outcome of Symptomatic Ureteral Stones

Is the 4.5-F ureteroscope (Ultra-Thin) an alternative in the management of ureteric and renal pelvic stones?

Difference in Operative Time According to Stone Location for Endoscopic Management of Ureteral and Renal Stones

A Clinical Nomogram to Predict the Successful Shock Wave Lithotripsy of Renal and Ureteral Calculi

Improvements in extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy have almost eradicated the need for open surgery in ureteral stones. The aim of this study was to assess characteristics of patients who underwent open ureterolithotomy. During a 5-year period, a total of 654 patients with ureteral stones were treated. Initial management consisted of ureteroscopy in 524 patients, ESWL in 62 patients and percutaneous nephrolithotomy (PCNL) in 12 patients. Open surgery was performed in 56 patients. Stone location, size and success rates were retrospectively analyzed. Ureteroscopy resulted in successful stone removal in 94%, 98% and 98.5% of proximal, mid and distal ureteral stones, respectively. A total of 14 patients with ureteroscopy failure were referred for open surgery. ESWL treatment resulted in success in 55 patients (88%), and those with ESWL failure were referred for either ureteroscopy (n = 3) or open surgery (n = 4). Open surgery was performed in a total of 56 patients, 38 of whom had been referred from other centers. Stone location was proximal ureter in 25 (44.6%) patients (stone size: 2-12 cm(2)), mid ureter in five (8.9%) patients (stone size: 2-6 cm(2)) and distal ureter in 26 (46.4%) patients (stone size: 4-9 cm(2)). A history of previous unsuccessful endourological procedure was observed in 33 (58%) of 56 patients. Children under age 16 (range 1-15 years) comprised 17.8% of patients undergoing open surgery. Open surgery, which is nowadays being replaced with laparoscopic techniques, is generally indicated for failed endourological procedures (58%), particularly in centers that do not have flexible ureteroscopy or laser lithotriptor, and in patients with larger stones (>3 cm). Children (17.8%) are also candidates for open surgery, if specifically designed endourological equipment is not available.

To compare the outcomes of extracorporeal shockwave lithotripsy with ureterorenoscopy and lasertripsy for managing upper ureteral stones of size 10mm to 15mm. Observational, cross-sectional study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), from December 2020 to December 2021. A total of 168 patients with the diagnosis of proximal ureteric stone of size 1-1.5 cm were enrolled for this study. Patients were divided into two groups by simple random method. Group 1 patients underwent ureteroscopic lithotripsy (URS) and lasertripsy while Group 2 patients were subjected to extracorporeal shockwave lithotripsy (ESWL). Patients' demography, operative time, duration of hospitalisation, complication rate and stone-free rates, were recorded for both groups. Frequency and percentages were calculated for categorical variables and mean and standard deviation were calculated for continuous variables. For comparison of continuous variables, one-way ANOVA was applied, and Chi-square test was applied to compare the categorical variables. The p-value ≤0.05 was taken as significant. The mean age was of 39.55 ± 14.06 years, with the majority falling within the age group of 26 to 40 years. There were more males (116, 69%) than females (52, 31%). Most of the patients did not have a history of diabetes or hypertension. Sixty-two patients had previous history of stones. The average duration of ureteric stone disease was 3.18 ± 3.14 months. The mean size of the ureteric stone was 10.82 ± 3.19mm. The procedure duration was significantly shorter for URS, as compared to ESWL (33.81 ± 15.42 minutes vs. 45.00 ± 0.00 minutes, p=<0.01. The overall stone clearance rate was significantly higher after URS (83.3%) as compared to ESWL (64.2%, p=0.05). URS was a superior treatment option as compared to ESWL. However, the selection of the most appropriate procedure should be based on a tailored approach considering the patient's preference and the size of the stones. Extracorporeal shockwave lithotripsy (ESWL), Ureteroscopic lithotripsy (URS), Modified clavien classification system (MCCS), Ureteric stone.

Purpose: We evaluated the effect of tamsulosin on upper and lower ureteral stones that were smaller than 10mm to identify the patient groups for which tamsulosin was most applicable. Materials and Methods: 85 patients who were diagnosed with ureteral stones smaller than 10mm in size were enrolled in this randomized prospective study. The patients were diagnosed via intravenous pyelography and then they were followed with weekly plain abdomen films for 4 weeks. The control group (Group 1) was given an nonsteroidal antiinflammatory drug (NSAID) for pain medication, and they were instructed to ingest at least 2l of fluids daily. For the treatment group (Group 2) once daily 0.2mg tamsulosin was added. Both groups were compared for the size of stone and the days to expulsion and pain control, based upon the number of emergency room (ER) visits. The proximal and distal ureteral stones were separately evaluated, and the patients’ gender, age, stone size and stone position were analyzed to identify treatment efficacy. Results: The average stone size was 5.2±2.6mm in group 1 and 4.7±1.5mm in group 2 (p=0.344). The success rate was 42.9% in group 1 and 76.5% in group 2 (p=0.005). Group 2 showed a significant reduction for the time to stone expulsion at 12.7±6.6 days compared to 18.5±6.9 days for group 1 (p=0.008). Among the subset of patients, those with distal ureteral stones smaller than 5mm alone showed a significant increase in the expulsion rate (100%, p=0.047) and a decrease of the days to expulsion (12.1±5.1 days, p=0.018). Conclusions: Tamsulosin increases the spontaneous expulsion rate and reduces the time to expulse ureteral stones, and it was most effective for distal stones less than 5mm in size. (Korean J Urol 2007;48:724-730) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

IntroductionWe intended to evaluate the feasibility and effectiveness of the simultaneous rigid and flexible ureteroscopic treatment of symptomatic ureteral and ipsilateral small simultaneous calyceal stones. Outcomes of combined therapy were compared with monotherapy alone.Material and methodsIn this retrospective study, group 1 consisted of 45 patients with middle or lower ureteral and ipsilateral small simultaneous calyceal stones treated by combined therapy. Group 2 included 45 patients with middle or lower ureteral stones only and treated by monotherapy. Stone characteristics, operative time, hospital stay, stone free rates, and complications were compared between groups 1 and 2. Stone free status was defined as no fragments and/or the presence of asymptomatic fragments smaller than 4 mm.ResultsMean BMI were 29.3 ±0.9 kg/m2 and 27.6 ±0.6 kg/m2 in groups 1 and 2, respectively. Mean ureteral stone size (7.6 ±0.4 mm vs. 8.0 ±0.4 mm, p = 0.261) and ureteral stone burden (56.0 ±5.5 mm2vs. 54.8 ±6.1 mm2, p = 0.487) were similar between groups. Mean renal stone size and renal stone burden for group 1 were 7.1 ±0.8 mm and 83.7 ±11.3 mm2. The mean operative time was significantly longer (for a mean of 32.5±1.2 minutes) for group 1 (p = 0.001). Ureteral stents were left in 38 (84.4%) and 19 (42.2%) patients in group 1 and group 2 (p = 0.001). Hospital stay and complication rates were similar between groups. SFRs were 100% for ureteral stones in both groups and 88.9% for renal stones within group 1.ConclusionsSimultaneous ureteroscopic treatment of the ureteral and ipsilateral small calyceal stones prolongs operative time and increases use of ureteral stent without leaving any residual renal stones.

Tamsulosin and Spontaneous Passage of Ureteral Stones in Children: A Multi-Institutional Cohort Study

PROSPECTIVE RANDOMIZED TRIAL COMPARING SHOCK WAVE LITHOTRIPSY AND URETEROSCOPY FOR MANAGEMENT OF DISTAL URETERAL CALCULI