Management Of Upper Ureteral Calculi Research Articles

HO:YAG LASER VS PNEUMATIC LITHOTRIPSY WITH SEMI RIGID URETEROSCOPE FOR PROXIMAL URETERAL CALCULI : OUR INSTITUTIONAL EXPERIENCE

Introduction & objectives: Different modalities are available for proximal ureteric stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet lithotripsy has favorable outcomes. In our randomized study, we included 100 patients who underwent semi rigid ureteroscopic pneumatic lithotripsy or laser lithotripsy. This study aims to compare the outcome of PL and LL in the management of upper ureteric calculi. 100 patients were a Materials & methods: dmitted in Govt Kilpauk medical college and hospital between January 2021 to June 2022 & randomized 50 cases of URS with pneumatic lithotripter and 50 cases of URS with laser lithotripter were enrolled. Patients with urinary tract infection, radiolucent stones, loss of follow-up, concurrent middle or lower third ureteral stones or acute renal failure were excluded. All patients underwent semi-rigid URS with Ho:YAG laser or pneumatic lithotripsy followed by DJ stenting. The aim of this study to compare the stone-free rate, assess the complications, duration of surgery and assess the need for second procedure , if retropulsion of calculus occurred following PL and LL. Demographically, no s Results: tatistical different in both groups in view of age, gender, mean size of stones (P> 0.05). Retropulsion occurred in 16% of the PL group (P< 0.05) and required auxillary procedure. There was a statistical difference in terms of stone free rate of stone in favor of LL group (p≤0.05) and mean operative time in favor of the PL group (p≤ 0.05). Conclusions: In both techniques, acceptable results were achieved. We found that both the PL and LL approaches were effective and safe for proximal ureteric calculi. LL method had advantages in more stone free rate, lower retropulsion rate but longer procedure duration compare to the PL method

COMPARISON OF ANTEGRADE PERCUTANEOUS VERSUS RETROGRADE URETEROSCOPIC LITHOTRIPSY FOR MANAGEMENT OF UPPER URETERIC CALCULUS.

Background: Technical advancements in urology have profoundly changed the management of upper ureteric calculus, however, its optimal management remains controversial. Methods: To compare antegrade percutaneous nephrolithotripsy (PCNL) and retrograde ureteroscopic lithotripsy (URSL) for management of upper ureteric calculus by measuring stone clearance rates, morbidity and complications. A prospective, observational, single centre, study including patients of either sex presenting with upper ureteric stone [size>8 mm and >800 Hounseld Unit (HU)]. Patients underwent either antegrade PCNL or retrograde ureteroscopic lithotripsy with follow up on outpatient (OPD) basis at 1 week, 1 month and 3 months post-surgery with Visual Assessment Score (VAS) and radiological investigations. Results: Stone clearance rate for antegrade PCNL was 89.1 % and 72.7% for retrograde ureteroscopic lithotripsy which is a statistically signicant difference. Incidence of pain in antegrade PCNL at 1st and 4th week follow-up was 10.9 % and 1.8% respectively compared to 5.5% and 0% for retrograde ureteroscopic lithotripsy. Two patients (1.8%) who underwent PCNL developed segmental artery pseudoaneurysm; one was managed conservatively while other required angioembolization. One patient in the antegrade PCNLgroup and two in retrograde ureteroscopic lithotripsy group had post operative urine culture proven urinary tract infection (UTI) and were treated with antibiotics. Conclusion:As compared to retrograde ureteroscopic lithotripsy, PCNLis a safer and more effective procedure with higher stone-free rates and acceptable complication rates to treat patients with large impacted upper ureteral stones.

Outcome of Semi-rigid Ureteroscopy with LASER Lithotripsy for Management of Upper Ureteric Calculi

Background: Proximal ureteral calculi are common with multi-modalities of treatment, with continuous invention of new modalities. Aim of the work: To present the early experience with LASER lithotripsy using semi-rigid ureteroscopy for treatment of upper ureteral calculi, regarding safety and efficacy. Patients and Methods:Eighty patients with upper ureteral stones managed by LASER lithotripsy using semi-rigid ureteroscopy were included [30 prospective and 50 retrospective]. Patient evaluation included medical history, clinical examination with preoperative laboratory and radiological investigations. The outcome measure was stone free rate, Intra operative and Postoperative complications, operative time, hospitalization time, and post-operative analgesia. Results: During the period from January 2018 through February 2020 in 30 prospective cases but retrospectively in 50 cases done in the last two years, 68.8% of patients were males and 31.2% of them were females, mean of age was 43.70 with range from 20 to 66 years, and mean of BMI was 19.75 with range from 18 to 23 with laterality of 60% of patients was right but of 40% was left and stone opacity of 96.25% of patients was radio opaque, while, 3.75% was radio lucent stones the mean operative time was 50.78 minutes and mean duration of hospital stay was 1.3 days. In addition, 66.2% of patient needed JJ, 32.5% required ureteric catheter and 15% failed ESWL. The mean ureteral stone diameter was 10.81. The clearance rate 97.5%; two cases had migrated stone. Conclusion: Semirigid ureteroscope with LASER lithotripsy is an effective and safe procedure for management of large proximal ureteral stones with a lesser rate of stone migration needs use of flexible ureterorenoscopy.

Antegrade Percutaneous Versus Retrograde Ureteroscopic Lithotripsy in Upper Ureteric Cases

Background: The technical advancements in urology have profoundly changed the management of upper ureteric calculus. The present study compared antegrade percutaneous versus retrograde ureteroscopic lithotripsy in upper ureteric cases. Subjects and Methods: The present study was conducted at NRI Medical College & Hospital, Chinakakani, Mangalagiri Mandal, Andhra Pradesh from May 2013 to April 2014 on 60 patients with upper ureteric stones of both genders. Patients were divided into 2 groups. Group I patients were treated with antegrade percutaneous and group II with retrograde ureterolithotripsy. Outcome in both groups was recorded and compared. Results: The mean anesthetic time in group I was 82.4 minutes and in group II was 73.1 minutes, operative time was 45.2 minutes in group I and 58.4 minutes in group II, post- operative stay in group I was 2.6 days and in group II was 1.7 days, stone clearance was seen in 26 patients in group I and 22 in group II. Mean stone size in group I was 1.89 cm and in group II was 1.49 cm. Follow ups days were 71.2 in group I and 83.4 in group II. Clavien-Dindo categorization grade 0 was seen in 16 in group I and 13 in group II, grade 1 in 10 in group I and 12 in group II and grade 2 in 4 in group I and 5 in group II. The difference was significant (P< 0.05). There were 4 and 5 patients in group I and group II with post- operative complications (P< 0.05). Conclusion: Authors found that antegrade percutaneous has better stone clearance rates as compared to retrograde ureterolithotripsy for an upper ureteric calculus.

Comparison of antegrade percutaneous versus retrograde ureteroscopic lithotripsy for upper ureteric calculus for stone clearance, morbidity, and complications

Introduction:The optimal management of upper ureteric calculus remains controversial. We compare the outcomes of antegrade percutaneous ureterolithotripsy (APCUL) with retrograde ureteroscopic lithotripsy (URSL) for upper ureteric calculus with respect to stone clearance, morbidity, and complication rates.Materials and Methods:This prospective study was carried out from December 2014 to June 2016. A total of 117 patients with upper ureteric calculus sized (10–20) mm who underwent APCUL or URSL were included in the study.Results:APCUL and URSL were performed in 64 and 53 patients, respectively. The mean age and stone size were comparable between the two groups. The stone clearance rate at 1-month follow-up was 93.75% in the antegrade group and 81.13% in the retrograde group (P = 0.036). Mean anaesthesia time was significantly longer for the APCUL group while the actual mean operative time was significantly longer for the URSL group (P < 0.001). The overall complication rate was higher in antegrade group (P = 0.804), whereas most of the major complications (Clavien Grade III or more) occurred only in the URSL group (P = 0.007). Blood transfusion was required only in the APCUL group (7.8% versus 0%; P = 0.50). In the URSL group, stone retropulsion occurred in four patients, of which three subsequently required shock wave lithotripsy and one required percutaneous nephrolithotomy in a second sitting.Conclusion:APCUL has better stone-free rates as compared to URSL for an upper ureteric calculus of size 10–20 mm. Although the postoperative minor complications are higher in the antegrade group, severe complications occurred only in the retrograde group. Hence, antegrade approach can be considered as the preferred option to achieve better stone clearance in a single sitting with acceptable morbidity and complication rates.

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group

Background: pediatric stone disease is one of the most common urological issues in pediatric urology practice. The incidence of urinary stone disease is increasing in children in last decades. Aim of the Work: determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in management of ureteric stones in pediatric age group. Patients and Methods: this study included 40 patients in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A: Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible ureteroscopy and laser lithotripsy. Results: there was no statistically significant difference found between the two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and there was highly statistically significant difference between the two groups regarding duration of the procedure which is more prolonged in flexible group. Conclusion: flexible URS lithotripsy and laser are considered a safe, highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric calculi in children after failure of ESWL.

Flexible Ureteroscopy with Laser Lithotripsy versus Extracorporeal Shock Wave Lithotripsy in Management of Ureteric Stones in Pediatric Age Group

Background: pediatric stone disease is one of the most common urological issues in pediatric urology practice. The incidence of urinary stone disease is increasing in children in last decades. Aim of the Work: determination of the efficacy and outcome of flexible ureteroscopy using holmium Yttrium aluminium garne laser lithotripsy and compare its results with that of Extracorporeal shock wave lithotripsy EWSL in management of ureteric stones in pediatric age group. Patients and Methods: this study included 40 patients in pediatric age group. Complaining of upper ureteric stones less than (1cm). Patients underwent either ESWL or Flexible Ureteroscopy randomly according to 1: 1 ratio. The procedures were done at Eldemerdash hospital and National Institute of Urology and Nephrology. The patients were divided into two groups. Group A: Patients undergone extracorporeal shock wave lithotripsy (ESWL). Group B: Patients received flexible ureteroscopy and laser lithotripsy. Results: there was no statistically significant difference found between the two studied groups regarding age, sex, size and BMI, and stone free rate. Also there was highly statistically significant difference as regard hospital stay. The SWL group required a shorter period of hospitalization and there was highly statistically significant difference between the two groups regarding duration of the procedure which is more prolonged in flexible group. Conclusion: flexible URS lithotripsy and laser are considered a safe, highly efficient, minimally invasive, and reproducible surgery technique -with a higher stone free rates and less postoperative complications, after a single procedure, when compared to ESWL- for management of upper ureteric calculi in children after failure of ESWL.

A comparative study between extracorporeal shock wave lithotripsy and ureterorenoscopic lithotripsy in the management of upper ureteric calculus

Introduction and Objective: A stone in the ureter usually comes from the kidney. Urolithiasis is the third most common disease of the urinary tract which is surpassed only by urinary tract infections and pathologic conditions of prostate. There are some controversies on the effectiveness of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URSL) in ureteral stones. We aim to compare the efficacy of ESWL and URSL in the management of upper ureteric stones in terms of stone clearance.Materials and Methods: This prospective hospital based study included patients with upper ureteric calculus managed with URSL with DJ stenting or ESWL at Dhulikhel Hospital-Kathmandu University Hospital from August 2014 to December 2015. Stone size, stone clearance, number of sittings, complications and need of other procedure were recorded.Results: Total number of patients undergone ESWL was 49 and URSL was 48. There was no difference in male/ female ratio, age and stone diameter between two groups (P&gt;0.05). Total stone-free ratio was 85.71%(42/49) for ESWL and 81.25%(39/48) for URSL, partial fragmentation requiring shift of modality of treatment was 12.24%(6/49) for ESWL and 12.5%(6/48) for URSL, failed procedure was 2.04%(1/49) for ESWL and 6.25%(3/48%) for URSL(P= 0.577).Conclusion: ESWL is as effective as URSL in the management of upper ureteric calculus with no significant difference in age, male/female ratio, stone diameter and stone free ratio

A Prospective Randomized Comparison Between Shockwave Lithotripsy and Semirigid Ureteroscopy for Upper Ureteral Stones &lt;2 cm: A Single Center Experience

The best management of upper ureteral calculi is undefined. We performed a prospective randomized comparison between semirigid ureteroscopy (URS) and shockwave lithotripsy (SWL) for upper ureteral stones <2 cm to evaluate safety and efficacy of both procedures. Patients with a single radiopaque upper ureteral stone <2 cm undergoing treatment between January 2010 and May 2011 in our department were included. Randomization was performed into two groups-group A: SWL performed as an outpatient procedure using an electromagnetic lithotripter (Dornier Compact Delta); group B: URS performed using an 6/7.5F semirigid ureteroscope with holmium laser intracorporeal lithotripsy. Statistical analysis was performed regarding demographic profile, success rates, retreatment rates, auxiliary procedures, and complications. There were 90 patients enrolled in each group. Mean stone size: 12.3 mm in group A vs 12.5 mm in group B (P=0.52). The overall 3-month stone-free rate was (74/90) 82.2% for group A vs (78/90) 86.6% for group B (P=0.34). For stone size <10 mm, 3-month stone-free rates were (45/53) 84.9% for group A vs (43/49) 87.7% for group B (P=0.32). For 10 to 20 mm stones, 3-month stone-free rates were (29/37) 78.4% for group A vs (35/41) 85.4% for group B (P=0.12).The re-treatment rate was significantly greater in group A than group B (61.1% vs 1.1%, respectively; P<0.001). The auxiliary procedure rate was comparable in both groups (21.1% vs 17.7%; P=0.45). The complication rate was 6.6% in group A vs 11.1% in group B (P=0.21). Both SWL and semirigid URS are safe and highly efficacious for treating patients with proximal ureteral stones <20 mm. For stones <10 mm, SWL was safer, less invasive, and of comparable efficacy with URS. For stones between 10 and 20 mm, however, URS was more effective, with a lesser re-treatment rate.

Editorial Comment

The authors share their experience of treating large proximal ureteral stones using semirigid ureteroscopes and a pneumatic lithotripter. At first glance, it would appear that overall they achieved remarkably outstanding stone-free rates. However, there was a 20% rate of failed initial ureteroscopy (7% in women, 35% in men), which is not surprising given the fact that the authors were using large-diameter (8-13.5 F) instruments. The higher failure rate in men is not surprising and reflects the fact that the male lower urinary tract anatomy at times is just not suited for ureteroscopy of the proximal ureter. The mere fact that 80% of the time the proximal stone was accessed is a testament to the expertise of the authors in performing semirigid ureteroscopy. Semirigid Ureteroscopy in Management of Large Proximal Ureteral Calculi: Is There Still a Role in Developing Countries?UrologyVol. 77Issue 5PreviewTo evaluate the outcome and complications of the use of semirigid ureteroscopy (URS) together with intracorporeal pneumatic lithotripsy in the management of upper ureteral calculi >10 mm in diameter. Full-Text PDF ReplyUrologyVol. 77Issue 5PreviewWe share the same opinion as the editors that if flexible instruments and holmium laser lithotripsy were available, they would be the first choice in the management of large proximal ureteric stones. However, we all know how expensive the cost of such equipment is in developing countries, making them available only in extremely selected institutes. We offer semirigid ureteroscopy to patients, knowing that we would expect a failure rate, to spare them the other alternative, open surgery. As the editors' state, “… the higher failure rate in men is not surprising and reflects the fact that the male lower urinary tract anatomy at times is just not suited for ureteroscopy of the proximal ureter.” Full-Text PDF

Semirigid Ureteroscopy in Management of Large Proximal Ureteral Calculi: Is There Still a Role in Developing Countries?

To evaluate the outcome and complications of the use of semirigid ureteroscopy (URS) together with intracorporeal pneumatic lithotripsy in the management of upper ureteral calculi >10 mm in diameter. A total of 75 patients (41 women and 34 men), with a mean age of 48 years (range 25-60), underwent primary URS for solitary radiopaque proximal ureteral calculi 10-20 mm in diameter (average 13.1). Dilation of the intramural ureter was done in 60 cases (80% of patients), and intracorporeal lithotripsy was required in 56 (74.6%). Ureteral catheters were left for drainage in 60% of patients, 26.7% were left unstented, and only 13.3% required an indwelling stent. Of the 75 stones, 60 (80%) were successfully cleared after a single endoscopic procedure. Our initial stone-free rate was 90.6% at 2 weeks after the primary endoscopic procedure and had reached 98.6% at 3 months. Antegrade URS for migrating stones was done successfully in 6 cases in a tubeless fashion, and open ureterolithotomy was required in 1 case. No major complications were encountered. The minor complications included only mild extravasation and self-limited postoperative fever and hematuria. The risk factors for URS failure included male gender, the severity of the hydronephrosis, the severity of impaction, and the occurrence of extravasation. The results of our study have shown that semirigid URS is a safe and successful alternative to open ureterolithotomy in the management of large proximal ureteral calculi in the absence of flexible instruments.

Shock Wave Lithotripsy Versus Semirigid Ureteroscopy for Proximal Ureteral Calculi (

To use a matched-pair analysis design to compare the safety and efficacy of shock wave lithotripsy (SWL) and ureteroscopy (URS). Controversy still exists regarding whether SWL or URS is the best management of upper ureteral calculi. We reviewed the records of patients with a single radiopaque upper ureteral stone treated by URS or SWL from January 2003 to December 2005. SWL was performed as an outpatient procedure using the electromagnetic lithotripter (Dornier Lithotripter S). URS was performed using an 8F or 8.5F semirigid ureteroscope. Intracorporeal lithotripsy with pneumatic or holmium laser energy was used when needed. A matched-pair analysis was performed using 3 parameters (sex, stone size, and degree of hydronephrosis). The success rates, retreatment rates, auxiliary procedures, and complications were compared in each group. A total of 427 patients were treated for upper ureteral stones. Forty-three matched pairs were identified and compared. The success rate was 83.7% for SWL vs 88.4% for URS (P = .8). The retreatment rate was significantly greater in the SWL group than in the URS group (65% vs 2.3%, respectively; P < .001). The need for auxiliary procedures was equal in both groups (16.3%). The complication rate was 14% in the URS group and 4.7% in the SWL group (P = .1). SWL and semirigid URS are highly effective in the treatment of proximal ureteral stones <20 mm. The results of our study showed that SWL was safer and less invasive, but that URS was more effective and resulted in a lower retreatment rate.

Solo extracorporeal shock wave lithotripsy for management of upper ureteral calculi with hydronephrosis.

The aim of this study was to evaluate extracorporeal shock wave lithotripsy (SWL) outcomes as a solo therapy in patients with upper ureteral calculi and varying degrees of hydronephrosis. Eighty patients with upper ureteral calculi and a body mass index between 19.5 kg/m2 and 22.5 kg/m2 were included. They were categorized into 4 groups according to the severity of hydronephrosis as seen on ultrasonography and intravenous urography: group 1, no dilatation; group 2, mild dilatation; group 3, moderate dilatation; and group 4, severe dilatation of the pyelocaliceal system. The size of calculi, time to calculus clearance, success rate of solo SWL, and the need for additional therapeutic methods were recorded and compared between the four groups of patients. The median size of the calculi was 13.5 mm, and the mean time to calculus clearance was 56.0 +/- 24.2 days. In 71.3% of the patients, solo SWL was successful in the treatment of the calculi. Twenty-three patients required other therapies including double-J stenting, ureteroscopy, and nephrolithotomy. The patients without hydronephrosis and those with severe hydronephrosis (groups 1 and 4) showed a significant difference in the days to clearance of the calculus (mean, 31.7 days versus 85.6 days; P < .001). Patients with upper ureteral calculi and mild hydronephrosis can be effectively treated with solo SWL therapy. In those with moderate hydronephrosis, clearance takes longer or requires secondary interventions. In patients with severe hydronephrosis, we recommend alternative/adjunctive procedures.

POD-02.07: Management of proximal ureteric calculi: pre and post holmium laser era

Evolution of smaller endoscopes and powerful energy sources has changed management concepts of proximal ureteric calculi. We retrospectively analysed efficacy of Holmium Laser in the management of upper ureteric calculi.

Management of Upper Ureteral Calculi with Extracorporeal Shock wave Lithotripsy

The results of 471 extracorporeal shock wave lithotripsy treatments in 465 patients with solitary ureteral stones managed by several different techniques are reported. In situ treatment was performed in 123 cases without instrumentation and in 47 after placement of a ureteral catheter. Retrograde stone manipulation was performed in 245 cases immediately before extracorporeal shock wave lithotripsy and an additional 56 were manipulated with ureteral stent placement at least 1 week before extracorporeal shock wave lithotripsy. The success rate was significantly greater if the stone was manipulated into the kidney before extracorporeal shock wave lithotripsy. Significantly less energy (p less than 0.0001) was required for complete disintegration if the stone was free floating in the kidney. The need for subsequent procedures was significantly less (p less than 0.0001) for stones manipulated successfully before treatment. More than 85 per cent of the ureteral calculi were manipulated successfully into the kidney. Complications were infrequent, with the most common being ureteral perforation in 5.1 per cent of the cases, all of which were managed conservatively.Extracorporeal shock wave lithotripsy is the treatment of choice for proximal ureteral calculi because it is less morbid than percutaneous approaches and provides significantly better results than ureteroscopy. An attempt at manipulation of proximal ureteral calculi back into the kidney should be made before extracorporeal shock wave lithotripsy.