Proximal Ureteral Stones Research Articles

Chronic kidney disease affects the stone-free rate after extracorporeal shock wave lithotripsy for proximal ureteric stones

Chronic kidney disease affects the stone-free rate after extracorporeal shock wave lithotripsy for proximal ureteric stones

The effectiveness of antegrade percutaneous approach on impacted proximal ureteral stones

The effectiveness of antegrade percutaneous approach on impacted proximal ureteral stones

Treatment of Ureteral Calculi with Semirigid Ureteroscopy: Where Should We Stop?

Objectives: To evaluate the efficacy of semirigid ureteroscopy in the management of ureteral stones located in different parts of the ureter. Methods: 1,503 patients were treated with semirigid ureteroscopy. All ureteral stones were either removed only by a basket catheter or disintegrated by pneumatic lithotripsy. Success rates, auxiliary procedures, complication rates and operation time were comparatively evaluated according to stone location. Results: Overall, mean stone size and age were 12.1 ± 3.7 mm and 43.2 ± 9.72 years, respectively. While 1,416 patients (94.2%) were completely stone-free, the procedure was unsuccessful in 87 cases (5.8%). The success rate was relatively low in the proximal ureter (71.7%) when compared with the mid (94.8%) and distal ureter (98.9%) (p = 0.021). Mean operation time was 25.4 ± 11.7 min. Longer duration of operation and higher complication rate were found in proximal ureteral calculi. Stone migration to the kidney and hematuria were the main reasons of failure in the proximal ureter and ureteral stenting was needed for 56.4% of patients with upper ureteral stone. Conclusions: Semirigid ureteroscopy can be the treatment of choice in lower and midureteral stones. However, it is an invasive and less successful treatment modality for proximal ureteral stones with relatively high complication rates.

1450 A PROSPECTIVE RANDOMIZED COMPARISON BETWEEN SHOCK WAVE LITHOTRIPSY AND SEMI-RIGID URETEROSCOPY FOR UPPER URETERIC STONES LESS THAN 2 CM: A SINGLE CENTRE EXPERIENCE

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal I1 Apr 20101450 A PROSPECTIVE RANDOMIZED COMPARISON BETWEEN SHOCK WAVE LITHOTRIPSY AND SEMI-RIGID URETEROSCOPY FOR UPPER URETERIC STONES LESS THAN 2 CM: A SINGLE CENTRE EXPERIENCE Anup Kumar, Manoj Jain, Sanjay Prakash, and Nayan Mohanty Anup KumarAnup Kumar More articles by this author , Manoj JainManoj Jain More articles by this author , Sanjay PrakashSanjay Prakash More articles by this author , and Nayan MohantyNayan Mohanty More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1164AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We have performed a prospective randomized comparison between semi-rigid ureteroscopy and shock wave lithotripsy for upper ureteric stones less than 2 cm to evaluate safety and efficacy of these procedures. METHODS All the patients with a single radio-opaque upper ureteric stone < 2 cm undergoing treatment between Jan 2008 and May 2009 in our department were included. Patients were randomized into 2 groups – Group A: SWL was performed as an outpatient procedure using the electromagnetic lithotripter (Dornier Alpha Compact); Group B: URS was performed using an 6/7.5 F or 8/9.8 F semirigid ureteroscope with pneumatic or holmium laser intracorporeal lithotripsy energy. The statistical analysis was performed in 2 groups regarding patient demographic profile, success rates, retreatment rates, auxiliary procedures, and complications. RESULTS 90 patients were enrolled in each group. The mean stone size was 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 (43/51) 84.3% for group A vs (44/51)86.3% for group B(p=0.32).For stone size between 10-20 mm, 3 month stone free rates were (31/39)79.5% for group A vs (35/39)89.7% for group B(p=0.12).The retreatment rate was significantly greater in group A in comparison to 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). CONCLUSIONS Both SWL and semirigid URS are safe and highly efficacious in the treatment of proximal ureteral stones < 20mm.For upper ureteric stones < 10 mm,SWL was safer, less invasive and with comparable efficacy in comparison to URS.However,for upper ureteric stones between 10-20 mm,URS was more effective, with a lesser retreatment rate than SWL. Delhi, India© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e559 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anup Kumar More articles by this author Manoj Jain More articles by this author Sanjay Prakash More articles by this author Nayan Mohanty More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Chronic kidney disease affects the stone‐free rate after extracorporeal shock wave lithotripsy for proximal ureteric stones

To investigate the effect of renal function on the stone-free rate (SFR) of proximal ureteric stones (PUS) after extracorporeal shock wave lithotripsy (ESWL), as urinary obstruction caused by PUS can impair renal function, and elevated serum creatinine levels are associated with decreased ureteric stone passage. From January 2005 to December 2007, 1534 patients had ESWL for urolithiasis, 319 having ESWL in situ for PUS; they were reviewed retrospectively. Patients requiring simultaneous treatment of kidney stones, placement of a double pigtail stent, or percutaneous pigtail nephrostomy tube were excluded. We divided patients into groups by chronic kidney disease (CKD) stage according to the estimated glomerular filtration rate (eGFR) of ≥ 60 and <60 mL/min/1.73 m(2). Stone-free status was defined as no visible stone fragments on a plain abdominal film at 3 months after ESWL. A logistic regression model was used to evaluate the possible significant factors that influenced the SFR of PUS after ESWL, and to develop a prediction model. The overall SFR of PUS (276/319 patients) was 86.5%; the SFR was 93% in patients with an eGFR of ≥ 60 and 50% in those with an eGFR of <60 (P < 0.001). After univariate and multivariate analysis, the three significant factors affecting SFR were an eGFR of ≥ 60, stone width, and gender, with odds ratios (95% confidence intervals) of 19.54 (8.25-46.30) (P < 0.001), 0.67 (0.55-0.82) (P < 0.001) and 0.16 (0.05-0.50 (P = 0.002), respectively. A logistic regression model was developed to estimate the probability of SFR after ESWL, the equation being 1/(1 + exp [-(3.8137 - 0.3967 × (stone width) + 2.9724 × eGFR - 1.8120 × Male)]), where stone width is the observed value (mm), eGFR = 1 for eGFR ≥ 60 and 0 for <60, and male = 1 for male, 0 for female. Gender, eGFR ≥ 60 and a stone width of >7 mm were significant predictors affecting the SFR after one session of ESWL for PUS.

Does tamsulosin change the management of proximally located ureteral stones?

The objective of this study is to assess the efficacy of an alpha-1 adrenergic receptor blocking agent on the spontaneous passage of proximal ureteral calculi < or =10 mm. 92 patients having single radio-opaque proximal ureteral stone < or =10 mm were randomized into two groups. Group 1 patients (n = 50) were followed with classical conservative approach and patients in Group 2 (n = 42) additionally received tamsulosin, 0.4 mg/day during 4 weeks follow-up. The stone passage rates, stone expulsion time, VAS score, change in colic episodes, and hospital re-admission rates for colicky pain were compared. The patients were furthermore stratified according to stone diameters <5 and 5-10 mm. The data of these subgroups were also compared. Stone expulsion rates showed statistically significant difference between tamsulosin receivers and non-receivers (35.7 vs 30%, p = 0.04). Time to stone expulsion period was also shortened in those receiving tamsulosin (8.4 +/- 3.3 vs 11.6 +/- 4.1 days, p = 0.015). Likewise, the mean VAS score and renal colic episodes during follow-up period were significantly diminished in Group 2 patients (4.5 +/- 2.3 vs 8.8 +/- 2.9, p < 0.01 and 66.6 vs 36%, p = 0.001, respectively). Among the stones <5 mm, tamsulosin receiving patients had higher spontaneous passage rate (71.4 vs 50%, p < 0.001). The prominent effect of tamsulosin on the 5-10 mm stones was the relocation of the stones to a more distal part of ureter (39.3 vs 18.7%, p = 0.001). Administration of tamsulosin in the medical management of proximal ureteral calculi can facilitate the spontaneous passage rate in the stone <5 mm and the relocation of the stones between 5 and 10 mm to more distal part of the ureter.

Percutaneous Nephrolithotomy for Proximal Ureteral Calculi with Severe Hydronephrosis: Assessment of Different Lithotriptors

We compared the efficacy and safety of percutaneous nephrolithotomy (PCNL) with different intracorporeal lithotriptors for proximal ureteral stones in patients with severe hydronephrosis. We retrospectively analyzed the records of 192 patients with proximal ureteral calculi and severe hydronephrosis who underwent PCNL between February 2003 and December 2007. Calculi were fragmented with a pneumatic lithotriptor in 44 patients (group 1), Swiss Lithoclast Master in 54 (group 2), low-power holmium:yttrium-aluminum-garnet (YAG) laser in 56 (group 3) and high-power holmium:YAG laser in 38 (group 4). Patients were assessed about 12 months postoperatively with intravenous urography and ultrasonography for late complications. Stone size, operative time, stone-free rate, and follow-up were analyzed in each group. Mean stone size for different groups were 16.2 +/- 2.8 mm, 16.6 +/- 2.1 mm, 16.0 +/- 2.7 mm, and 16.4 +/- 1.1 mm, respectively. Average operative time for different groups were 118 +/- 17 minutes, 81 +/- 10 minutes, 85 +/- 14 minutes, 110 +/- 16 minutes, respectively. Group 2 and group 3 showed superior outcomes of shorter operative time (P = 0.000). The overall stone-free rate was 86.5%. As stratified by lithotriptors, the stone-free rate was 81.8% in group 1, 92.9% in group 2, 88.9% in group 3, and 78.9% in group 4 (P = 0.190). No significant difference was found among the groups in terms of blood loss and postoperative hospital stay. Repeated PCNL or shockwave lithotripsy was necessary as an auxiliary procedure in 26 patients. The overall complication rate was 18.2%; most complications were minor and insignificant. During the follow-up, ureteral stricture developed in 10 patients and new renal stones developed in 4 patients. PCNL combined with Swiss Lithoclast Master or low-power holmium:YAG laser is the preferred endourologic modality for the management of proximal ureteral calculi in patients with severe hydronephrosis.

Comparison of Patient Satisfaction with Treatment Outcomes between Ureteroscopy and Shock Wave Lithotripsy for Proximal Ureteral Stones

PurposeWe examined patient satisfaction with treatment outcomes after shock wave lithotripsy (SWL) and ureteroscopic removal of stone (URS) for proximal ureteral stones.Materials and MethodsWe evaluated 224 consecutive patients who underwent SWL (n=156) or URS (n=68) for a single radiopaque proximal ureteral stone. Stone-free rates, defined as no visible fragment on a plain X-ray; complications; and patient satisfaction were compared. Patient satisfaction was examined through a specifically tailored questionnaire that included overall satisfaction (5 scales) and 4 domains (pain, voiding symptoms, cost, and stone-free status).ResultsThe stone-free rates after the first, second, and third sessions of SWL were 36.5%, 65.4%, and 84.6%, respectively. The overall stone-free rate of URS was 82.4%, which was comparable to that of the third session of SWL. Complications were similar between the two groups except for greater steinstrasse in the SWL group. Overall satisfaction and voiding symptoms, cost, and stone-free status showed no significant difference between the groups. In the pain domain, the SWL group had a relatively lower satisfaction rate than did the URS group (p=0.05). Subanalysis showed that the satisfaction rate of the URS group with stone-free status was significantly lower than that of the SWL group in patients with ≥10 mm stones (p=0.032).ConclusionsOverall treatment outcomes and patient satisfaction were not significantly different between SWL and URS. However, patients undergoing URS for ≥10 mm proximal ureteral stones had lesser satisfaction with stone-free status, because of relatively lower stone-free rates due to upward stone migration. We suggest that factors regarding the subjective satisfaction of patients be included in counseling about treatment options for proximal ureteral stones.

Treatment of large proximal ureteral stones: extra corporeal shock wave lithotripsy versus semi-rigid ureteroscope with lithoclast

PurposeAssessment of safety and efficacy of extracorporeal shockwave lithotripsy versus semi-rigid ureteroscope with lithoclast for treatment of large proximal ureteral stones.Materials and methodsThe study included 147 patients with large upper ureteral stones. SWL and ureteroscopy were performed in 71 and 76 patients respectively. Patients in the SWL group were treated with Siemens: - Modularis lithovario under intravenous sedation on an out patient basis. Patients in the ureteroscopy group were treated with (7.5 Fr) semi-rigid ureteroscope and lithoclast under spinal anesthesia on a day care basis.ResultsStone - free rate for in situ SWL was 58% (41 of 71) patients. For semi-rigid ureteroscope accessibility of the stones was 94% (72 of 76) and the stone free rate was 92% (70 of 76) No major complications were encountered in both groups.Mean stone size was 1.34 ± 0.03 cm in the SWL group and 1.51 ± 0.04 in the ureteroscopy group.ConclusionsOur study demonstrates that ureteroscopy with lithoclast can be considered as acceptable treatment modality for large proximal ureteral calculi and can be considered as fist line for treatment of large proximal ureteral stones.

Efficacy of extracorporeal shock wave lithotripsy for ureteral stones in children

In this study, we retrospectively analyzed our experience with extracorporeal shock wave lithotripsy (ESWL) in children with ureteric stones. Between 1997 and 2008, 115 children with ureteral stones were treated by ESWL in our department. There were 67 boys and 48 girls with a mean age of 7.2 + or - 4.3 years. There were 53 (46.1%) patients with proximal ureteric stones, 16 (13.9%) with mid-ureteral stones and 46 (40.0%) with distal ureteral stones. The stone size ranged from 4 to 21 mm with a mean of 7.38 mm. Children with proximal stones were treated in the supine position, while children with mid and distal ureteric stones were treated in the prone or supine position. Stone-free rate at 3 months was 94.8%, the re-treatment rate 15.7%, and overall efficacy quotient (EQ) was 83%. SWL failed in six children (5.2%). There was no significant difference in stone-free rates at 3 months between different groups classified by location and stone size. There were no serious side effects. Our results indicate that ESWL with highly satisfactory stone-free rates and negligible complications can be considered as a first-line treatment for ureteric stones in the pediatric age group.

UP-3.176: Remedial Treatment of Failure in Ureterscopic Lithotripsy in 126 Proximal Ureteral Stone Patients

Ureteroscopic lithotripsy fail to treat of proximal ureteral stones sometimes. we summarize the experience of appropriate minimally invasive treatment of failure in ureteroscopic lithotripsy in treatmenting proximal ureteral stone.

Bilateral ureter stones in a 1-year-old boy

Sirs, We have read with great interest the study by Spivacow et al. regarding metabolic risk factors in children with kidney stone disease [1]. The authors found biochemical abnormalities in 84.4% of 90 children, with hypercalciuria and hypocituria being the two most common causes. This high incidence of biochemical abnormalities matched with results reported in previous studies [2, 3] that had recommended screening for metabolic abnormalities in pediatric urolithiasis even in patients with documented urinary tract anomalies. A urinary tract anomaly has long been considered a predisposing condition for the formation of calculi, with the associated urinary stasis considered to promote crystal retention and stone formation. However, several recent reports have questioned this theory and have suggested that, in patients with urinary tract anomalies, stone formation is caused by underlying metabolic abnormalities [4, 5]. We would like to present a case which demonstrates the difficulty of immediate diagnosis of stone pathogenesis in patients with urinary tract abnormalities. We describe here a case of bilateral ureter stones in a 1-year-old boy in whom tortuosities of both ureters was observed. A 1-year-old boy was referred to our hospital because of diarrhea and oliguria. The boy was delivered uneventfully at 38 weeks of gestation and had a birth weight of 3190 g. Prenatal ultrasonography during the second trimester of pregnancy did not reveal any abnormalities, and a family history of stone disease in first-degree relatives was denied. Upon referral, the boy had been lethargic and anuric for 10 h after having had watery diarrhea for the previous 7 days. The results of blood analyses were as follows: tCO2, 12 mEq/L; blood urea nitrogen, 16.3 mg/dL; creatinine, 0.7 mg/dL. Urinalysis was not performed because of the anuria, which persisted despite isotonic saline infusion. At the 12-h follow-up examination, serum creatinine had increased to 1.1 mg/dL, and the acidosis persisted (pH 7.249; tCO2 13.7 mEq/L). Renal ultrasonography revealed hydronephrosis, and nonenhanced computed tomography showed bilateral proximal ureter stones with moderate attenuation. Percutaneous nephrostomy (PCN) of both kidneys using a 6-Fr pigtail catheter was performed to relieve the ureteral obstruction, and alkalinization of urine with an intravenous sodium bicarbonate infusion was initiated on hospital day (HD) 2. After the PCN procedure, serum creatinine level dropped rapidly from 1.9 to 0.8 mg/dL, and urinary flow through a Foley catheter was observed on HD 3. Antegrade pyelography (AGP) via a PCN catheter on HD 7 confirmed that both ureters were fluent and that calculi were absent, but it also revealed tortuosities of both ureters at the ureteropelvic junction. As the ureter calculi were lysed during alkalinization, stone analysis could not be conducted. Urine drained from the renal pelvis at the time of catheter insertion was acidic (pH 5.5), and there was a high ratio of uric Pediatr Nephrol (2009) 24:2077–2078 DOI 10.1007/s00467-009-1182-1

Extracorporeal Shock Wave Lithotripsy in Prepubertal Children: 22-Year Experience at a Single Institution With a Single Lithotriptor

The sophistication of percutaneous nephrolithotomy and ureteroscopy challenges the efficacy of ESWL for urolithiasis in prepubertal patients. We evaluated our long-term experience with ESWL in these patients and determined its efficiency. We retrospectively reviewed the charts of all prepubertal patients who underwent ESWL. We evaluated the need for tubing, the 3-month stone-free rate, the need for additional ESWL, and the effect of stone size and location, and cystinuria on the 3-month stone-free rate. Between 1986 and 2008, 119 males and 97 females with a mean age of 6.6 years who had urolithiasis underwent ESWL using the Dornier HM3 lithotriptor. We treated 157 children with renal calculi with an average +/- SD diameter of 14.9 +/- 8.9 mm, of whom 66 (42%) required a tube in the urinary system. The 3-month stone-free rate was 80% and 31 patients (19.7%) needed an additional procedure. Stone location did not affect the stone-free rate but stone size did. We treated 59 patients for ureteral stones with an average stone length of 9.5 +/- 4.8 mm, of whom 41 (69%) required tube insertion. The 3-month stone-free rate was 78% and 13 patients (22%) needed an additional procedure. The 3-month stone-free rate did not depend on stone location or size. The rate was 37.5% in patients with cystinuria and 82.5% in all others (p <0.0001). Six patients (2.8%) had complications. The 3-month stone-free rate after ESWL in prepubertal patients is 80% and 20% of patients require additional procedures. ESWL is most effective for kidney stones less than 11 mm. ESWL has inferior results for cystine stones compared to other calculi. Complications are rare.

A Randomized, Double-Blind Trial to Compare Shock Wave Frequencies of 60 and 120 Shocks per Minute for Upper Ureteral Stones

Recent evidence demonstrates that decreasing shock wave frequency from the previous standard of 120 to 60 shocks per minute results in improved fragmentation of stones located within the renal collecting system. We report the first randomized trial to our knowledge to examine the effect of a slower shock wave frequency for shock wave lithotripsy on stones located in the proximal ureter. A total of 163 patients with a previously untreated radiopaque calculus in the upper ureter measuring at least 5 mm underwent stratified block randomization according to stone size, and shock wave lithotripsy at 60 or 120 shocks per minute. Stone-free status at 3 months was confirmed with noncontrast computerized tomography or a plain abdominal x-ray and ultrasound study. Of the patients 77 were randomized to 60 shocks per minute and 86 were randomized to 120 shocks per minute. The groups were similar in gender, age, body mass index and initial stone area. At 3 months the 60 shocks per minute group had a higher overall stone-free rate (64.9% vs 48.8%, p = 0.039). Significantly fewer shocks were administered to patients treated at 60 shocks per minute (mean 2,680 vs 2,940, p <0.001). However, mean treatment times were longer (44.3 vs 24.5 minutes, p <0.001). Patients treated with 60 shocks per minute required fewer auxiliary procedures (29.9% vs 45.4%) (p = 0.031). Decreasing the rate of shock wave administration from 120 to 60 shocks per minute results in improved stone-free rates. A slower treatment rate of proximal ureteral stones reduces the need for additional shock wave lithotripsy or more invasive treatments to render patients stone-free, without any increase in morbidity, and with an acceptable increase in treatment time.

Ureteral Stone Location at Emergency Room Presentation With Colic

It is thought that the 3 narrowest points of the ureter are the ureteropelvic junction, the point where the ureter crosses anterior to the iliac vessels and the ureterovesical junction. Textbooks describe these 3 sites as the most likely places for ureteral stones to lodge. We defined the stone position in the ureter when patients first present to the emergency department with colic. We retrospectively reviewed the records of 94 consecutive patients who presented to the emergency department with a chief complaint of colic and computerized tomography showing a single unilateral ureteral calculus. Axial, coronal and 3-dimensional reformatted computerized tomography scans were evaluated, and stone position and size (maximal axial and coronal diameters) were recorded, as were the position of the ureteropelvic junction, the iliac vessels (where the ureter crosses anterior to the iliac vessels) and the ureterovesical junction. Patients with a history of nephrolithiasis, shock wave lithotripsy, ureteroscopy or percutaneous nephrolithotripsy were excluded from study. Statistical analysis was performed using Student's t test and Pearson's correlation coefficient. At the time of emergency department presentation for colic ureteral stone position was the ureteropelvic junction in 10.6% cases, between the ureteropelvic junction and the iliac vessels in 23.4%, where the ureter crosses anterior to the iliac vessels in 1.1%, between the iliac vessels and the ureterovesical junction in 4.3% and at the ureterovesical junction in 60.6%. Proximal calculi had a greater axial diameter than distal calculi (mean 6.1 vs 4.0 mm) and a greater coronal diameter than distal calculi (6.8 vs 4.1 mm, each p <0.001). Axial and coronal diameters moderately correlated with stone position (r = -0.47 and -0.55, respectively, each p <0.001). Proximal ureteral stones were larger in axial and coronal diameter than distal ureteral stones. At emergency department presentation for colic most stones were at the ureterovesical junction and in the proximal ureter between the ureteropelvic junction and the iliac vessels. A few stones were at the ureteropelvic junction and only 1 lodged at the level where the ureter crosses anterior to the iliac vessels, despite the literature stating that these locations are 2 of the 3 most likely places for stones to become lodged.

Tablets of the potassium citrate may cause a stone-like image: a case report

An 8-year-old girl with left proximal ureteral stone (4 mm) was referred to our hospital to treat with shock wave lithotripsy (SWL). Fifteen days after the first SWL session, a plain film of kidneys, ureters and bladder (KUB) demonstrated a new stone-like opacity (10 mm) on the left kidney location other than previous stone of 4 mm. We counseled with her parents and learned that she took a potassium citrate tablet 2 h before. Potassium citrate is a radio-opaque drug and may cause a stone-like image during the stone management. Urologists should consider this particularity of potassium citrate in patients using this drug to avoid unnecessary interventions. To our knowledge, this is the first case in the literature.

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.

DO LITHOTRIPTORS MAINTAIN THEIR EFFECTIVENESS OVER TIME?

This study compared the efficacy and safety profile of electrohydraulic (EH) and electromagnetic (EM) lithotriptors in the treatment of 10- to 20-mm renal and proximal ureteric stones at a single center and by a single operator.Between January 2001 and December 2006, we sequentially treated patients meeting study inclusion criteria with MPL 9000 Dornier EH for the first 3 years, followed by the EM Siemens Modularis shockwave lithotripsy (SWL) unit. A single operator performed all SWL treatments under the supervision of an admitting urologist. We analyzed the demographic features and stone- and treatment-related parameters including complications for both groups. In each group, the stone-free rate and efficiency quotient was determined at 1-3 months.Of 274 patients, we sequentially treated 112 using the EH lithotriptor, and 162 the EM lithotriptor. The pre-SWL patients and stone-related parameters were similar in the two groups, except for diagnostic imaging modalities. The mean number of SWL sessions, need for ancillary procedure, retreatment rate, stone location, stone-free rate, and efficiency quotient were not significantly different between groups. The mean number of shockwaves required for complete fragmentation was 2977 and 6044 (P < .000) for the EH and EM groups, respectively.Single center, single operator experience with two types of lithotriptor indicated that both are equally efficacious, with similar safety profiles. The only significant difference was that the EH lithotriptor required fewer shockwaves for fragmentation.

MULTI-INSTITUTIONAL ANALYSIS DEMONSTRATES THAT STONE SIZE IS ONLY INDEPENDENT PREDICTOR OF SWL SUCCESS IN CHILDREN

We compared the clinical outcomes of patients with ureteral or renal stones treated with ureteroscopy, shock wave lithotripsy using HM3 (Dornier®) and nonHM3 lithotripters, and percutaneous nephrolithotomy.A systematic literature search identified 6, 4 and 3 randomized, controlled trials of treatment of distal and proximal ureteral stones, and renal stones, respectively, published between 1995 and 2010. Overall stone-free, re-treatment and complication rates were calculated by meta-analytical techniques.Based on the randomized, controlled trials evaluated the treatment of distal ureteral stones with semirigid ureteroscopy showed a 55% greater probability (pooled RR 1.55, 95% CI 1.13–2.56) of stone-free status at the initial assessment than treatment with shock wave lithotripsy. Patients treated with semirigid ureteroscopy were also less likely to require re-treatment than those treated with shock wave lithotripsy (nonHM3) (RR 0.14, 95% CI 0.08–0.23). The risk of complications was no different between the 2 modalities. Only 2 of the 4 randomized, controlled trials identified for proximal ureteral stones evaluated flexible ureteroscopy and each focused specifically on the treatment of stones 1.5 cm or greater, limiting their clinical relevance. The degree of heterogeneity among the studies evaluating renal stones was so great that it precluded any meaningful comparison.Semirigid ureteroscopy is more efficacious than shock wave lithotripsy for distal ureteral stones. To our knowledge there are no relevant randomized, controlled trials of flexible ureteroscopy treatment of proximal ureteral calculi of a size commonly noted in the clinical setting. Collectively the comparative effectiveness of ureteroscopy and shock wave lithotripsy for proximal ureteral and renal calculi is poorly characterized with no meaningful published studies.

FLEXIBLE URETEROSCOPY FOR PROXIMAL URETERAL STONES IN OBESE AND NON-OBESE PATIENTS: SINGLE SURGEON OUTCOMES

You have accessJournal of Urology1 Apr 2009FLEXIBLE URETEROSCOPY FOR PROXIMAL URETERAL STONES IN OBESE AND NON-OBESE PATIENTS: SINGLE SURGEON OUTCOMES Sara L Best and Stephen Y. Nakada Sara L BestSara L Best More articles by this author and Stephen Y. NakadaStephen Y. Nakada More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)61282-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "FLEXIBLE URETEROSCOPY FOR PROXIMAL URETERAL STONES IN OBESE AND NON-OBESE PATIENTS: SINGLE SURGEON OUTCOMES." The Journal of Urology, 181(4S), pp. 451–452 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 451-452 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Sara L Best More articles by this author Stephen Y. Nakada More articles by this author Expand All Advertisement PDF downloadLoading ...