Percutaneous Ultrasonic Lithotripsy Research Articles

AB076. Compare the treatment of urolithiasis in a microchannel percutaneous nephrolithotomy pneumatic lithotripsy and open surgery

ObjectiveThe aim of this study is to compare the treatment of urolithiasis in a microchannel percutaneous nephrolithotomy ultrasonic pneumatic lithotripsy and open stone surgery.MethodsJanuary 2014–October 2014 in our hospital treated 43 cases of patients with kidney stones as the observation group, the use of micro-channel percutaneous nephrolithotomy lithotripsy; and 48 cases of patients with urolithiasis in March 2013~December 2013 were treated as the control group, the use of open stone surgery treatment.ResultsIt was observed in patients with clinical manifestations and complications during surgery, after statistical comparison of the results were analyzed. Observation group and control group operative time was no difference (P>0.05), hospitalization time in the observation group was shorter than the control group (P<0.05). Bleeding volume in the observation group was less than the control group (P<0.05). A clearance rate in the observation group was higher than the control group (P<0.05), the incidence of complications in the observation group was less than the control group (P<0.05).ConclusionThe difference was statistically significant. Significant effect of microchannel percutaneous nephrolithotomy is smaller surgical trauma and shorter hospital stay.

Application of fast-track surgery in perioperative nursing of patients with percutaneous nephrolithotomy lithotomy with upper-pole access

Objective To explore the effectiveness of fast-track surgery （ FTS） in perioperative nursing of patients with percutaneous nephrolithotomy lithotomy with upper-pole access （PCNL）.Methods Seventy-six kidney stone （ KS） patients with PCNL in our hospital from November 2011 to December 2013 were chosen and randomly divided into the control group and the intervention group , each with 38 cases.The control group received the routine nursing , and the intervention group received the FTS nursing intervention .The hospital stays, the costs of treatment , the score of BI index of living scale and the incidence of complication were recorded and the patients ’ satisfaction were investigated at the end of nursing in two groups .Results The hospital stays, the costs of treatment, the score of BI index of living scale were respectively （8.8 ±2.3） d, （10 980.6 ±966.3）yuan and （84.6 ±9.4） in the intervention group, and were better than （12.4 ±3.0）d, （14 315.3 ±1 537.3） yuan and （68.9 ±7.3） in the control group, and the differences were statistically significant （t =4.682, 9.473, 6.741, respectively;P 〈0.05）.The incidence rate of complication in the intervention group was 10.5% including 2 cases of postoperative fever and 2 cases of postoperative pain , and was better than 31.6% including 4 cases of severe bleeding , 6 cases of postoperative fever , and 2 cases of postoperative pain in the control group , and the difference was statistically significant （χ2 =5.067, P〈0.05）. The patients’ satisfaction was 94.7%in the intervention group, and was high than 78.9%in the control group, and the difference was statistically significant （χ2 =4.145,P〈0.05）.Conclusions FTS nursing intervention adopted in KS patients with PCNL during perioperative period can effectively reduce the incidence of complications , and be accepted by the patients , and which is worthy of further promotion in clinical practice . Key words: Kidney stone; Perioperative nursing; Fast-track surgery; Percutaneous nephroscope ultrasonic lithotripsy

Effect of individual nursing on renal fistula in renal calculi patients with percutaneous nephroscope ultrasonic lithotripsy

Objective To explore the effect of individual nursing on renal fistula in renal calculi patients with percutaneous nephroscope ultrasonic lithotripsy （PNUL）. Methods One hundred and eighty-four patients with renal calculi from March 2010 to March 2013 were chosen and divided into the study group and the control group according to the random number table, each with 92 cases. All patients received the PNUL, and the control group received the routine nursing after the operation, and the study group received the individual nursing on the basis of routine nursing. The time of hospitalization and pulling out fistula, the occurrence of complication after the operation were compared between two groups. Results The time of hospitalization and pulling out fistula in the study group were respectively （7.98 ± 1.68） , （5.12 ± 1.66） d, and were less than （10.23 ± 2.54）, （7.54 ± 1.12 ） d in the control group, and the differences were statistically significant （t = 2. 824,2. 537, respectively;P 〈 0. 05 ）. The blockage and infection of fistula were not found in the study group; the incidence rate of fistula abscission was 1.09% in the study group, and was 11.96% in the control group, and the difference was statistically significant （ X2 = 8. 915, P 〈 0. 01 ）. The satisfaction of nursing was 98.91% in the study group, and was 78.26% in the control group, and the difference was statistically significant （X2 = 114.649, P 〈 0. 01 ）. Condusions The individual nursing of renal fistula in renal calculi patients with PNUL can effectively reduce the occurrence of complication after the operation, and ensure the curative effect and the success rate of operation. Key words: Renal calculi; Lithotripsy; Renal fistula; Individual nursing

Percutaneous nephrolithotomy combined with endoscopic balloon dilation in the treatment of upper ureterostenosis with recurrent renal calculi

Objective To analyze the technique and clinical effect of percutaneous nephrolithotomy combined with endoscopic balloon dilation in the treatment of upper ureterostenosis with recurrent renal calculi. Methods From June 2008 to June 2011,18 ureteral stenosis patients with the history of ureteral open surgery,postoperative residual or recurrent kidney stones were treated.There were 8 males and 10 females with the age of 27 -48 years.Fourteen cases were with hydronephrosis of 2 -4 cm,3 cases were with hydronephrosis of 5 -6 cm and 1 case was with hydronephrosis ＞6 cm.Subsequent stone size ＜ 1 cm was found in 15 cases,1 -3 cm in 3 cases,＞3 cm in 1 case.All patients were treated with percutaneous nephrolithotomy ultrasonic lithotripsy combined with balloon dilatation.The stone clearance rate,hydronephrosis changes,complications and IVP situation before and after surgery were analyzed. Results All the 18 cases were completed surgery successfully.There was 1 (6％) case with renal hemorrhage 3 days after the surgery and controlled with DSA hemostasis.There was 1 case accepted adjusting double-J tube by ureteroscopy.Sixteen (89％) patient's stones were completed removed.One case with residual calyceal stones size ＜5 mm was not further treated.There was 1 case treated with nephrectomy because of renal stone with infection.The patients were followed up for 6 to 36 months.Fourteen cases with hydmnephrosis improved significantly; 3 cases with no significant changes but improved following balloon dilation.All patients achieved significant improvement in imaging study comparing of preoperative and postoperative data. Conclusion The use of percutaneous nephrolithotomy combined with endoscopic balloon dilation is a safe and efffective treatment option in the treatment of kidney stones with ureteral stenosis. Key words: Nephrostomy,percutaneous; Percutaneous nephrolithotomy; Balloon dilation; Hydronephrosis; Ureteral stenosis

1888 CHANGING STONE COMPOSITION IN RECURRENT STONE FORMERS

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal IV1 Apr 20101888 CHANGING STONE COMPOSITION IN RECURRENT STONE FORMERS Kashif Alvi, Mohummad Siddiqui, Ahmad Sharif-Tabrizi, Stephen Dretler, and Dianne Sacco Kashif AlviKashif Alvi More articles by this author , Mohummad SiddiquiMohummad Siddiqui More articles by this author , Ahmad Sharif-TabriziAhmad Sharif-Tabrizi More articles by this author , Stephen DretlerStephen Dretler More articles by this author , and Dianne SaccoDianne Sacco More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1842AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephrolithiasis is a recurrent condition in which approximately 50-70% of all stone formers have a risk of subsequent stone formation. Preventative treatment is based on the stone type as well as serum and urinary metabolic factors. The possibility that a recurrent stone former can make more than one stone type over time was evaluated. METHODS A medical record review was performed on 302 patients who had repeat stone analysis between 1988 and 2008. Stone analyses were performed on stones retrieved either after ureteroscopy/laser lithotripsy, percutaneous ultrasonic lithotripsy or from voided specimens. The same stone laboratory analyzed all these stones by x-ray crystallography. The stones were noted to be of following types: Calcium phosphate- Carbonate, Calcium oxalate monohydrate, Calcium oxalate dihydrate, Ammonium Urate, Brushite (Calcium hydrogen phosphate dihydrate), Struvite, Uric Acid, Cystine, Ammonium Urate, and Xanthine stones. RESULTS A total of 302 patients and 736 stone analyses were reviewed. Out of the 302 patients, 173 patients had change in their stone analyses over a certain period of time. A total of 193 stone analyses had changed from one mixed type to a different mixed type, 41 stone analyses changed from a pure stone type to a mixed stone type, 40 analyses changed from a mixed stone type to a pure stone type and 10 stone analyses had changed from one pure stone type to another pure stone type. Among 10 pure stone type changes, 5 stone analyses had a change from uric acid stone into calcium oxalate monohydrate & 2 analysis had changed from uric acid stone to calcium oxalate monohydrate stone. Hence, stone composition changed in 173 (57%) patients in this study upon repeat stone analysis. The most common stone composition change was calcium oxalate monohydrate. CONCLUSIONS Stone composition may change in recurrent stone formers with subsequent stone analysis. It is especillay important when one pure stone type is completely replaced by a totally different stone. These findings suggest that a solitary stone analysis may not be reliable in long term management of recurrent stone formers. Boston, MA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e734 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kashif Alvi More articles by this author Mohummad Siddiqui More articles by this author Ahmad Sharif-Tabrizi More articles by this author Stephen Dretler More articles by this author Dianne Sacco More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Neoinfundibulotomy For The Management Of Symptomatic Caliceal Diverticula

Direct percutaneous access provides effective treatment for complex caliceal diverticula. Yet, access into the diverticulum alone is usually tenuous and passage of a guide wire across a stenotic infundibulum is often impossible. An alternative technique is described which creates a "neoinfundibulum" to assist in the management of symptomatic caliceal diverticula. During a 6-year period 22 patients with symptomatic caliceal diverticula were treated via a percutaneous approach, of whom 21 had calculi within the diverticula. After accessing the diverticulum directly, it was impossible to pass a guide wire through the stenotic infundibulum in 18 (82%) patients, prompting advancement of the access needle through the diverticular wall into the renal pelvis. Once secure access was established, balloon dilation was performed to 30Fr to create the "neoinfundibulum." Percutaneous ultrasonic lithotripsy was performed in the usual fashion. A 22Fr Councill catheter was placed to keep the infundibular tract open for 5 to 7 days to allow complete epithelialization and drainage. Stone-free, symptom-free and complication rates were assessed. Pain, recurrent urinary tract infections and hematuria were the presenting complaints in the subgroup of patients undergoing "neoinfundibulotomy." Average stone burden was 11.7 x 12 mm. and average hospital stay was 2.8 days. Of the patients 94% were symptom-free at 6-week followup, and 80% were stone-free on followup excretory urography. The remaining patients had residual stone fragments less than 3 mm. in diameter. Complications related to access were identified in 2 patients who sustained a pneumothorax after a supra-11th rib access, which was successfully managed with tube thoracostomy. Percutaneous management of complex caliceal diverticula provides a safe and effective option for symptomatic patients. When the stenotic infundibulum cannot be traversed with a guide wire, creation of a new infundibulum offers a secure alternative for accessing the collecting system, while providing equally effective results.

CRITICAL ANALYSIS OF SUPRACOSTAL ACCESS FOR PERCUTANEOUS RENAL SURGERY

Percutaneous renal surgery is currently performed for complex renal calculi as well as for various other endourological indications. In many patients an upper pole nephrostomy tract allows direct access to most of the intrarenal collecting system. Upper pole percutaneous access may be obtained via the supracostal or subcostal approach. The preferred route depends on the location and size of the specific stone or lesion. Previously others have cautioned against the supracostal approach above the 12th rib and many have discouraged an approach above the 11th rib due to concern about the increased risk of intrathoracic complications. We retrospectively assessed the morbidity associated with supracostal percutaneous renal surgery and compared and analyzed the morbidity of the supracostal and subcostal approaches. The records of all patients who underwent upper pole percutaneous renal surgery between November 1993 and July 1999 were retrospectively reviewed. A total of 240 patients underwent percutaneous renal procedures, including 225 for managing symptomatic renal or ureteral stones, that is nonstaghorn calculi in 157, staghorn calculi in 41, proximal ureteral calculi in 12, calculi within a caliceal diverticulum in 6, calculi associated with primary ureteropelvic junction obstruction in 5 and calculi associated with a retained ureteral stent in 4. An additional 15 procedures were done for ureteropelvic junction obstruction (7), intrarenal collecting system tumors (5), a caliceal diverticulum without stones (1), a retained ureteral stent (1) and a ureteral stricture (1). A total of 300 nephrostomy tracts were placed to obtain access to the intrarenal collecting system via the supracostal approach in 98 (32.7%) cases and the subcostal approach in 202 (67.3%). Of the supracostal approaches 72 (73.5%) tracts were above the 12th and 26 (26.5%) were above the 11th rib. The overall complication rate irrespective of percutaneous approach was 8.3% (16.3% for supracostal and 4.5% for subcostal access). Complications included blood transfusion in 7 patients, intraoperative hemothorax/hydrothorax in 5, sepsis/bacteremia in 3, atrial fibrillation in 2, delayed nephropleural fistula in 2, renal artery pseudoaneurysm in 2, deep venous thrombosis/pulmonary embolus in 2, pneumothorax in 1 and subcapsular hematoma in 1. Seven of 8 intrathoracic complications (87.5%) developed in supracostal cases. Percutaneous renal surgery remains an important option for managing complex renal calculi and other upper urinary tract lesions. In our experience it is generally associated with low morbidity. The supracostal approach is often preferred for obtaining intrarenal access to complex renal and proximal ureteral pathology. Because supracostal access tracts are associated with significantly higher intrathoracic and overall complication rates compared to subcostal access tracts, this approach must be used with caution when no other alternatives are available.

UNENHANCED COMPUTERIZED AXIAL TOMOGRAPHY TO DETECT RETAINED CALCULI AFTER PERCUTANEOUS ULTRASONIC LITHOTRIPSY

Purpose We report our experience with unenhanced computerized axial tomography (CT) after percutaneous ultrasonic lithotripsy in patients thought to be at high risk for retained calculi. Materials and Methods CT was obtained in 121 patients (124 kidneys) within 12 to 36 hours of percutaneous ultrasonic lithotripsy for staghorn or large nonstaghorn renal calculi. Cases were grouped according to the CT findings as no retained calculi, insignificant retained calculi (fragments 1 to 3 mm.), retained calculi amenable to shock wave lithotripsy and retained fragments requiring second look percutaneous ultrasonic lithotripsy or flexible nephroscopy. Results No calculi were seen in 73 kidneys (59%) and retained calculi were identified in 51 (41%). Shock wave lithotripsy was used to treat 8 patients and another percutaneous ultrasonic lithotripsy or flexible nephroscopy was performed in 23 to remove retained stones. Insignificant calculi were noted in the remaining 21 patients. Conclusions We believe that postoperative unenhanced CT is superior to plain renal tomography and is the best method to determine if a patient is stone-free after percutaneous ultrasonic lithotripsy. It helps to locate precisely those stones requiring a second percutaneous ultrasonic lithotripsy or nephroscopic extraction. An unenhanced renal CT devoid of calculi obviates routine postoperative second look flexible nephroscopy. We encourage others to consider this technique to define more accurately kidney stone status after percutaneous ultrasonic lithotripsy for large staghorn calculi or in any patient at high risk for retained calculi after percutaneous ultrasonic lithotripsy.

How to Irrigate a Nephrostomy Tube

kidney stones, surgery may be the only remaining option. In percutaneous nephrolithotomy, for instance, the surgeon removes small stones through a nephroscope inserted through a percutaneous tract to the kidney. In percutaneous ultrasonic lithotripsy, larger stones, broken up by ultrasound, are removed via the nephroscope or are excreted in the urine. Or, calculi are removed by special loops or basket catheters inserted into the ureter

Endopyelotomy: Review of Results and Complications

Percutaneous endopyelotomy augmented by balloon dilation was performed on 27 of 40 patients for the treatment of symptomatic, primary ureteropelvic junction obstruction. Percutaneous ultrasonic lithotripsy was performed simultaneously on 12 of 27 patients (44%) for associated calculi. After endopyelotomy 24 of 27 patients became asymptomatic (clinical success rate 89%). Three clinically improved patients demonstrated only radiographic stability, while radiographic improvement was documented in 21 of 27 (radiographic success rate 78%). Adjuvant percutaneous ultrasonic lithotripsy was successful from the standpoint of stone removal in all patients and no increased morbidity could be identified.Of 27 patients 3 (11%) suffered major complications and are considered failures. Reasons for failure varied and are discussed. Included is a patient who at nephrostography and stent capping became septic and subsequently died. To decrease the risk of sepsis perioperative antibiotics to include at the time of nephrostomy tube capping are recommended. Angiography was performed in 19 of 40 patients to rule out an accessory crossing vessel at the ureteropelvic junction, and such a vessel was found in 6. From analysis of presenting excretory urograms (IVPs) we conclude that a crossing vessel cannot predictably be identified on an IVP.

Endourological Experience With Cystine Calculi and a Treatment Algorithm

Between May 1984 and January 1988, 18 patients (31 pyeloureteral units) with documented symptomatic cystine stones were treated. Stone size ranged from 5 to 56mm. in largest diameter, with an average of 21mm. All pyeloureteral units were treated initially by endourological methods, including ureteroscopy in 10, percutaneous ultrasonic lithotripsy in 9, extracorporeal shock wave lithotripsy (ESWL**Dornier Medical Systems, Inc., Marietta, Georgia.) in 10 and chemolysis in 2. Of the patients 10 required a combination of these technologies and 2 required an open operation. Of the 31 units 23 were free of stones when the patient was discharged from the hospital. Of 8 patients with retained stones only 3 had fragments greater than 3mm. in diameter.Based on this experience an algorithm was developed for the urological management of cystine stones. Ureteral calculi may be removed by ureteroscopic techniques or manipulated into the renal pelvis and managed as renal stones. Cystine renal calculi of less than 1.5cm. may be treated with ESWL monotherapy. Stones of 1.5 to 3cm. may be treated with ESWL and dissolution, or percutaneous ultrasonic lithotripsy plus dissolution. Staghorn calculi may be treated by percutaneous ultrasonic lithotripsy plus ESWL and/or dissolution for retained fragments.

Cost-Effectiveness Study of the Extracorporeal Shock-Wave Lithotriptor

We performed a cost-effectiveness analysis to examine the relative efficacy and costs of percutaneous ultrasonic lithotripsy (PUL), extracorporeal shock-wave lithotripsy (ESWL), and surgery for the treatment of upper urinary tract stones. We developed a Markov model with 35 states, cycles of 3 months, and a time frame of 5 years. Probability estimates were derived from a meta-analysis of the published literature. For stones less than or equal to 2 cm, ESWL is preferred to PUL, since it prevents 2 additional days of morbidity and saves $440. For larger stones, PUL is preferable to ESWL, avoiding 4 days of morbidity, and saving $722. Both ESWL and PUL were superior to surgery. Sensitivity analysis showed that the results are sensitive to ESWL efficacy rates, the stone recurrence rate, and the hospital component of the ESWL cost. Our analysis suggests that although ESWL is preferable, relatively small changes in the efficacy and cost can shift the preferred strategy; in addition, these findings underscore the need for more reliable data.

In Situ Extracorporeal Shock Wave Lithotripsy for Upper Ureteral Stones Using the Edap LT-01 Lithotriptor

We reviewed 64 cases of upper ureteral stones treated between December 1986 and June 1988. Upper ureteral stones were defined as stones in the ureter distal to the ureteropelvic junction and proximal to the Si vertebra. All stones were treated in situ with no invasive procedures done before treatment. The over-all success rate in rendering patients free of stones by extracorporeal shock wave lithotripsy monotherapy was 75%. Of the patients 25% required auxiliary procedures, such as percutaneous ultrasonic lithotripsy. The average duration of treatment for each stone was 88 minutes and the average storage energy used was 208 units.

Long-Term Followup in Patients with Cystine Urinary Calculi Treated by Percutaneous Ultrasonic Lithotripsy

From February 1983 through 1986, 15 patients (17 renal units) with cystine urinary lithiasis were treated by percutaneous ultrasonic lithotripsy. Three patients were lost to followup. Of the 13 renal units in the remaining 12 patients 7 (54 per cent) had retained stone fragments and 6 (46 per cent) were free of stones. While on medical management 7 of the 13 renal units (54 per cent) had new stones, 5 (38 per cent) remained unchanged and in 1 (8 per cent) the retained stones dissolved. The rate for reoperations was 43 per cent for the group with retained stones (3 of 7) and 17 per cent for the group that was free of calculi after percutaneous ultrasonic lithotripsy (1 of 6). Our study suggests that the optimal treatment with percutaneous ultrasonic lithotripsy should result in a patient who is free of stones.

Combined percutaneous ultrasonic lithotripsy and extracorporeal shock wave lithotripsy for struvite staghorn calculi

A group of patients with struvite staghorn calculi were treated by combining percutaneous ultrasonic lithotripsy (PUL) and extracorporeal shock wave lithotripsy. Stone free rates at a mean follow-up of six months were only 23%. Far superior results have been achieved with PUL above. The primary treatment of struvite staghorn should be with PUL. Shock wave lithotripsy should be reserved for fragments difficult or dangerous to access.

Staghorn calculi: endourologic management in 120 patients.

Symptomatic staghorn renal calculi were removed from 106 of 124 kidneys (85%) with percutaneous ultrasonic lithotripsy. All remaining fragments were less than 5 mm in greatest diameter, small enough to pass spontaneously. Use of two or more access routes was necessary in 91 kidneys (73%), and 29 patients (24%) required multistage nephrolithotripsy for complete stone removal. The total operative time averaged 162 minutes per patient. The average hospitalization period was 12.5 days, and the average convalescence time after discharge was 15 days. The most common adverse effect was bleeding necessitating transfusion (57%). Infection occurred in 27% of patients and may be intrinsic to removal of these infected stones. There was one death in the study group: a patient with multiple medical problems died of myocardial infarction. Successful stone extraction requires a clear understanding of renal anatomic features, properly placed access routes, and radiologic-urologic expertise. It is concluded that staghorn calculi can be safely and effectively treated with the use of percutaneous techniques.

Contralateral retroperitoneal hematoma secondary to percutaneous ultrasonic lithotripsy

We believe this is the first reported case of symptomatic contralateral retroperitoneal hematoma secondary to percutaneous ultrasonic lithotripsy.

The unbreakable stone?

A case of a failed percutaneous ultrasonic lithotripsy is reported as an unusual occurrence.

Long-Term Follow-Up of Patients Treated by Percutaneous Ultrasonic Lithotripsy for Struvite Staghorn Calculi

Between October 1981 and June 1984, partial or total struvite staghorn calculi in 74 renal units in 68 patients were managed solely by percutaneous methods. There were residual stones in 12 kidneys at the time of hospital discharge. An average of 34 months of follow-up has been obtained in 80% of these patients. Of the eight evaluable kidneys in which residual stones were present, five had stone regrowth. All patients in this group had urinary infection. Five of these patients, including all with stone recurrence, had predisposing anatomic or metabolic factors. Of the 57 evaluable kidneys that were stone free at discharge, five (9%) had recurrent calculi. Ten patients had urinary infections. Again, there were predisposing factors in most patients with recurrent infection or stones. A struvite stone patient rendered stone free by percutaneous ultrasonic lithotripsy who is treated for any metabolic abnormalities has a 90% chance of remaining stone free for at least 3 years. The likelihood may be even greate...

An Algorithm for the Management of Ureteral Calculi

We evaluated 158 patients with ureteral calculi (28 impacted in the ureteropelvic junction, 42 in the upper, 29 middle and 36 lower third of the ureter, and 23 in the intramural tunnel) treated by extracorporeal shock wave lithotripsy, percutaneous ultrasonic lithotripsy, ureteroscopic methods, chemolysis or surgery. Of the patients 92.5 per cent were treated successfully by endourological methods. Twelve patients (7.5 per cent) required an operation. Extracorporeal shock wave lithotripsy was successful in 61 per cent of the patients without placement of a ureteral stent and in 100 per cent in whom stent placement or stone dislodgement was successful. Ureteroscopic removal was successful in 52 of 56 patients with lower third and intravesical tunnel ureteral calculi. An algorithm for ureteral calculi management is developed, which emphasizes stent bypass and extracorporeal shock wave lithotripsy for upper third or ureteropelvic junction calculi, ureteroscopic removal or stent bypass with extracorporeal shock wave lithotripsy for middle third calculi, and ureteroscopic techniques for lower third and intramural tunnel calculi. Percutaneous ultrasonic lithotripsy, chemolysis and surgery are recommended as complementary methods.