Treatment Of Distal Ureteral Calculi Research Articles

Comparative study between Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for lower ureteral stones.

To compare the efficacy of Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for treatment of distal ureteral calculi. Over a period of 6 months (January 2022 to June 2022) this prospective randomized study was conducted on 170 patients with distal ureteric stone ≤ 10 mm. Patients were randomly divided into three groups. Patients in group A received Tamsulosin 0.4mg, in group B received Silodosin, and in group C receive Tadalafil 5 mg. Therapy was given for a maximum of 4 weeks. The rate and time of stone expulsion, the analgesic use, attacks of colic and hospital visits for pain, and adverse effects of drugs were recorded. Among 170 patients who were enrolled in study, 20 were lost to follow-up (7, 8, 5 in group A, B, And C respective-ly). There was a significant higher stone passage rate in group C than group A and B (90% vs. 70% and 76% respectively; p-value = 0.043) and shorter expulsion time in group C (8.7 ± 3.3 days) vs. group A (12.5 ± 5.2 days) and group B (11.3 ± 4.2 days) with (p-value = 0.001)(highly statistically significant with p-value < 0.001) and increased amount of analgesics required in group A (225 ± 115.7 mg) and group B (163 ± 77.5 mg) when compared with group C (120 ± 55.3 mg). Tadalafil is more effective than Tamsulosin and Silodosin in treatment of patients with distal ureteric stones ≤ 10 mm as regard stone expulsion rate, expulsion time with decreased number of colicky episodes and side effects.

Use of Extracorporeal Physical Vibration Lithecbole Through Greater Sciatic Foramen for Treatment of Distal Ureteral Calculi.

Introduction: To evaluate the efficacy and safety of performing extracorporeal physical vibrational lithecbole (EPVL) through greater sciatic foramen (GSF) for distal ureteral calculi (DUC) treatment. Materials and Methods: All patients with a diagnosis of DUC (6-10 mm in diameter) were enrolled in this study from October 2018 to May 2020. Patients were randomly divided into three groups receiving EPVL through GSF (Group A, n = 58), or abdominal (Group B, n = 60), or combined with oral use of tamsulosin at 0.4 mg daily (Group C, n = 63). Results: There was no significant difference observed in terms of demographic characteristics or size of stones among the three groups (p > 0.05). Compared with the Groups B and C, patients of the Group A displayed a significantly higher score of comfort, with a significantly decreased number of renal colic attacks or analgesics required (p < 0.01). The stone-free rate also significantly increased after 1 and 2 weeks of treatment (p < 0.01), despite such a significant difference among these groups vanishing after 4 weeks of treatment. Conclusion: EPVL in the prone position uses the GSF as the path and is a safe and effective approach to treat the distal ureteral calculi.

Efficacy and safety of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi of 5 to 10 mm in size: A systematic review and network meta-analysis.

To evaluate the Efficacy and safety of phosphodiesterase type 5 inhibitors as a medical therapy for distal ureteral calculi by means of a systematic review and network meta-analysis (NMA). We searched the Embase, Medline, and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCTs) published before May, 2017. Stone passage rate as the primary outcome. We used random effects model for pairwise meta-analyses and Bayesian random effects model for NMA. We evaluated the quality of evidence by the GRADE framework for each network estimate. Five RCTs (861 patients) comparing four different interventions. The results of NMA showed that compared with tamsulosin alone, tamsulosin combined with tadalafil group was associated with significantly higher stone passage rate (odds radio [OR] 2.55, 95% credible intervals [Crl] 1.11 to 5.89). When considering stone expulsion rate, compared with tamsulosin, silodosin was ranked best (OR 3.58, 95% Crl 1.13 to 11.91), followed by tamsulosin combined with tadalafil (OR 2.55, 95% Crl 1.11 to 5.89) and tadalafil alone (OR 1.86, 95% Crl 0.95 to 4.25). No significant difference was found considering safety profiles between any interventions. This meta-analysis indicates that tamsulosin combined with tadalafil is an effective treatment option for ureteral stones with a low occurrence of side effects. Clinicians should take all known safety and compliance of patients into account when choosing an optimal strategy. Since sample size of included studies, further RCTs are strongly encouraged to address the clinical question.

The Efficacy of Medical Expulsion Therapy in Distal Ureteric Calculi

Objective: To evaluate the efficacy of tamsulosin in the treatment of distal ureteric calculi.&#x0D; Materials and Methods: Forty patients, who meet the in­clusion criteria, were selected for the prospective study. All these patients re­ceived tamsulosin 0.4 mg once before bed time for fourteen days to observe the effectiveness, side effects and stone expulsion rate.&#x0D; Results: The average time of stone expulsion was 8.03±2.80 days. The successful medical expul­sion was seen in 82.50%. About 7.5% complained of dizziness and headache, 2.5% complained of fatigue and postural hypotension.&#x0D; Conclusion: The use of tamsulosin was safe, effective and was associated with fewer side effects. Successful stone expulsion rate was observed in in selected cases.

Treatment of Distal Ureteral Calculi Using Extracorporeal Physical Vibrational Lithecbole Combined with Tamsulosin: A New Option to Speed Up Obstruction Relief.

The obstruction of the urinary tract by calculi at the narrowest anatomical areas leads to impaired drainage and severe pain. The aim of this study was to evaluate a new technology, extracorporeal physical vibrational lithecbole (EPVL) combined with tamsulosin, as a treatment for distal ureteral calculi (DUC). Between July 2013 and July 2014, 672 patients diagnosed with DUC were randomly divided into three groups; a group receiving EPVL plus 0.4 mg oral tamsulosin daily (PO qd) (experimental group, n = 236), a group receiving 0.4 mg tamsulosin PO qd (n = 222), and a group receiving EPVL only (n = 214) (control groups). There were no significant differences in general characteristics between the three groups. Stone diameters ranged from 0.32 to 1 cm. In the EPVL plus tamsulosin group, 60.1% of patients showed detectable fragment expulsion at 48 hours, and 91.1% were stone free at 7 days. Compared with the two control groups, these rates were significantly higher (EPVL group was 0% and 50.5% and medical expulsive therapy group was 0% and 50.0%, p < 0.05). The stone-free rates were similar in the three groups 2 weeks later (94.5%, 93.6%, and 93.5%; p > 0.05). Patients in the EPVL plus tamsulosin group achieved similar stone-free rates compared with the other two groups, but the speed of the stone expulsion was quicker for both sexes and all age groups (about a week; p < 0.05). This indicates that EPVL plus tamsulosin could be used as an effective, but faster treatment option for patients with DUC, alleviating the symptoms of DUC in a shorter period of time.

Efficacy and safety of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi of 5-10mm in size: A systematic review and network meta-analysis

Efficacy and safety of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi of 5-10mm in size: A systematic review and network meta-analysis

Efficacy of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi: A systematic review and meta-analysis.

PurposeTo determine the efficacy of phosphodiesterase type 5 inhibitors (PDE5i) as medical expulsive therapy (MET) for the treatment of distal ureteral calculi.Materials and MethodsA search strategy was conducted in the MEDLINE, CENTRAL, and Embase databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of random effects due to statistical heterogeneity was conducted. The primary outcome was the expulsion rate of the distal ureteral calculus in 28 days. The secondary outcomes were the time to expulsion, side effects of treatment, and amount (mg) of nonopioid analgesia. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were PDE5i vs. placebo, tadalafil vs. placebo, and tadalafil vs. tamsulosin.ResultsFour articles were included in the qualitative and quantitative analysis. Records of 580 patients were found among the four studies. A low risk of bias was shown for the majority of the study items. The calculi expulsion rate had an RD of 0.26 (95% CI, 0.15–0.37) and a less prolonged expulsion as a secondary outcome with a mean difference of -4.39 days (95% CI, -6.69 to -2.09) in favor of PDE5i compared with the placebo. No significant difference was found for these outcomes when comparing tadalafil with tamsulosin.ConclusionsCompared with a placebo, PDE5i could be effective as MET for the treatment of distal ureter calculi.

Micro-ureteroscopy for the treatment of distal ureteral calculi in children

ObjectiveThe objective of this study was to demonstrate the efficacy and safety of micro-ureteroscopy (micro-URS) in the management of distal ureteral stones in the pediatric population. Materials and MethodsA total of 11 children, who had undergone micro-URS between September 2015 and April 2016 with the indication of distal ureteral calculi in two referral centers, were retrospectively evaluated. The procedures were performed with the patient in the lithotomy position under general anesthesia using the standard URS technique with a micro-ureteroscope that has a caliber of 4.85 Fr all along its length. Demographics, perioperative data, and outcomes were assessed. ResultsRight (n=6) and left (n=8) ureteral stones were detected in the respective number of patients. The mean age of the children was calculated as 55.1months (range, 6–161months). The median stone size was 10.5mm (range, 6–24mm). The median operative time was 36.8min (range, 23–68min). A double 3 stent was implanted in 3 of 11 patients because of severe edema. As a postoperative complication mild hematuria (Clavien grade 1) was observed in one case and resolved spontaneously. Intraoperative minor or major complication did not occur in any of the cases. The mean hospitalization time was determined as 21.4h (range, 10–28h). Stone-free status was accomplished in all patients in the final assessment. ConclusionThe outcomes of our series show that micro-URS can be used safely and effectively in the treatment of pediatric distal ureteral stones. Further prospective and comparative studies comparing instruments of different size are warranted.

Feasibility and outcome of emergency ureteroscopic removal of lower ureteral stone under intravenous sedation: A prospective study

ObjectiveTo compare the efficacy of emergency ureteroscopy (URS) with that of elective URS in the treatment of distal ureteral calculi. Patients and methodsThis prospective study included 132 patients diagnosed with a distal unilateral ureteral stone ≤5mm and treated with either emergency or elective URS between August 2013 and July 2014. The indication for emergency URS was intractable renal pain not responding to narcotic analgesia. Children, pregnant women and patients with bilateral disease were excluded. The patients were categorized into two groups: Group I included 42 patients who underwent emergency URS under intravenous sedation, while Group II included 90 patients who underwent elective URS. The patients’ demographic data, the stone criteria, perioperative complications, procedure outcome and degree of patient satisfaction were recorded and statistically analyzed. ResultsThe mean stone size was 4.2±0.5mm in Group I and 4.1±0.6mm in Group II. The success rate was 90.5% and 97.8% in Groups I and II, respectively with a statistically insignificant difference. Complete stone retrieval without fragmentation was achieved in 83.3% in Group I and in 82.2% in Group II. The stone migrated proximally in 4 patients in Group I and in only 2 patients of Group II; these patients received ureteral stents. Mucosal injury was observed in 3 and 4 patients of Groups I and II, respectively. Thirty-seven patients of Group I (88%) reported that they were satisfied with the procedure and its outcome compared to 78 patients of Group II (87%). ConclusionEmergency URS under intravenous sedation is feasible, safe and equally effective when compared to elective URS for small lower ureteral stones.

Outcome of ureteroscopy for the management of distal ureteric calculi: 5-years’ experience

ObjectiveTo review our 5 years’ experience with ureteroscopy treatment of distal ureteric calculi. Patients and methodsWe reviewed the medical records of 136 patients who underwent ureteroscopic procedures for the treatment of distal ureteric calculi from February 2007 to October 2012. Patient and stone characteristics, treatment modality and outcome were assessed. Procedure's duration, status “stone free” and hospital stay were also evaluated. The mean clinical and radiological follow-up period was 31.8 months for 74.2% of eligible patients. ResultsThe stone free rate following an initial ureteroscopy was 79.4. The ultimate success rate for stone removal after “second look” improved to 95.9%. The mean operative duration was 51minutes.The intraoperative complication rate was 8.6%, the postoperative complication rate was 7.5%, and the mean hospital stay was 1.1 days.We could detect one ureteric stricture and one vesico-ureteric reflux (0.9% for each). A significant ureteric perforation was detected in 4.1% and ureteric perforation in 0.7% of the study group.We could find that the longer the operative duration, the greater the complications.Stone impaction and size were also found associated with higher morbidity. ConclusionGrowing skills and experience of ureteroscopy will lead to a significant increase in the success rate and also reducing serious complications.

Ureteral stenting after uncomplicated ureteroscopy for distal ureteral stones: a randomized, controlled trial.

Objectives. We compared outcome and complications after uncomplicated ureteroscopic treatment of distal ureteral calculi with or without the use of ureteral stents. Materials and Methods. 117 patients, prospectively divided into three groups to receive a double j stent (group 1, 42 patients), ureteral stent (group 2, 37 patients), or no stent (group 3, 38 patients), underwent ureteroscopic treatment of distal ureteral calculi. Stone characteristics, operative time, postoperative pain, lower urinary tract symptoms (LUTS), analgesia need, rehospitalization, stone-free rate, and late postoperative complications were all studied. Results. There were no significant differences in preoperative data. There was no significant difference between the three groups regarding hematuria, fever, flank pain, urinary tract infection, and rehospitalisation. At 48 hours and 1 week, frequency/urgency and dysuria were significantly less in the nonstented group. When comparing group 1 and group 3, patients with double j stents had statistically significantly more bladder pain (P = 0.003), frequency/urgency (P = 0.002), dysuria (P = 0.001), and need of analgesics (P = 0.001). All patients who underwent imaging postoperatively were without evidence of obstruction or ureteral stricture. Conclusions. Uncomplicated ureteroscopy for distal ureteral calculi without intraoperative ureteral dilation can safely be performed without placement of a ureteral stent.

A novel technique for treatment of distal ureteral calculi: early results.

A novel technique for treatment of distal ureteral calculi: early results.

Holmium: YAG Laser Lithotripsy Versus Pneumatic Lithotripsy for Treatment of Distal Ureteral Calculi: A Meta-Analysis

The objective of this study was to estimate the treatment effect of Pneumatic Lithotripsy (PL) versus holmium: YAG laser lithotripsy (LL) in the treatment of distal ureteric calculi. A bibliographic search covering the period from 1990 to April 2012 was conducted using search engines such as MEDLINE, EMBASE, and Cochrane library. Data were extracted and analyzed with RevMan5.1 software. A total of 47 studies were scant, and 4 independent studies were finally recruited. Holmium: YAG LL conveyed significant benefits compared with PL in terms of early stone-free rate [odds ratio (OR)=4.42, 95% confidence interval (CI) (1.14, 17.16), p=0.03], delayed stone-free rate [OR=4.42, 95%CI (1.58, 12.37), p=0.005], mean operative time [WMD=-16.86, 95%CI (-21.33, -12.39), p<0.00001], retaining double-J catheter rate [OR=0.44, 95%CI (0.25, 0.78), p=0.004], and stone migration incidence [OR=0.26, 95%CI (0.11, 0.62), p=0.003], but not yet in the postoperative hematuria rate and the ureteral perforation rate according to this meta-analysis. Precise estimates on larger sample size and trials of high quality may provide more uncovered outcomes in the future.

Tamsulosin as medical expulsive therapy for lower ureterolithiasis: A meta-analysis

ObjectiveTo review the evidence for tamsulosin as medical expulsive therapy in enhancing the effectiveness of distal ureteral stone clearance rate. MethodsWe searched Pubmed/Medline, Embase, CBM and the Cochrane Library up to October 2011. All randomized controlled trials in which tamsulosin was evaluated with distal ureterolithiasis were eligible for the analysis. Outcome measure assessed was stone clearance rate. Two authors independently assessed study quality and extracted data. All data were analyzed using RevMan 5.1. ResultsThirteen studies involving 1067 participants met the inclusion criteria. Study duration ranged from 7 to 42 d. The pooled analysis showed an improvement of 41% in stone clearance rate of tamsulosin as medical expulsive therapy for distal ureteral calculi (RR=1.41, 95%CI=1.18 to 1.70). According to stone size (6 mm<size<10 mm, 5 mm<size<6 mm, size <5 mm), the pooling effects of tamsulosin were analyzed, with a higher stone expulsion rate obtained than control (RR=1.52, 1.75, 1.05, 95%CI=1.30 to 1.77, 1.25 to 2.45, 0.95 to 1.16, respectively). Adverse effects of tamsulosin, mainly retrograde ejaculation, dizziness and hypotension, were reported in 7 included trials. ConclusionTreatment with tamsulosin appears to be a safe and effective medical expulsion therapy for distal ureterolithiasis. To make a definite clinical recommendation to use tamsulosin as medical expulsive treatment for distal ureteral calculi, high quality multicentric, randomized, double blinded, controlled trials are necessary to prove its efficacy.

Extracorporeal shock wave lithotripsy for distal ureteral calculi: Improved efficacy using low frequency

To compare low versus high frequency for lithotripsy in the management of distal ureteral calculi. A total of 154 patients with radio-opaque calculi (0.5-1 cm diameter) in the distal ureter were randomized to be given either lithotripsy at 80 or 60 pulses per min (high frequency or low frequency groups, respectively). The number of waves and sessions received, and time to total resolution were measured. A Dornier Compact Delta lithotripter was used. A total of 72 patients were assigned to the high frequency group and 78 to the low frequency group. Four patients were excluded from the study because of intolerance of the procedure. The size was slightly lower in low frequency group, whereby an analysis of covariance was carried out to eliminate the size factor, with the limit established as 0.7 cm. The low frequency group received 2980 ± 1211 waves, and the high frequency group received 5752 ± 3121 (P<0.001). The success rate was higher in the low frequency group (100%) than in the high frequency group (92.9%; P=0.02). If adjusted to the size of the calculus with a threshold of 0.7 cm, there was a difference, although it was not statistically significant. The time to elimination of the fragments was higher in the high frequency group (17.68 days) than in the low frequency group (7.15 days; P<0.001). The number of sessions necessary for resolution was higher in the high frequency group (1.56) than in the low frequency group (1.14; P<0.001). Lithotripsy at 60 pulses provides better outcomes than lithotripsy at 80 pulses for the treatment of distal ureteral calculi.

Combination solifenacin and tamsulosin for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy

Objective To evaluate the efficacy of combination solifenacin and tamsulosin for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy. Methods 120 patients (male:100 female:20 age:18-67 yrs) randomly assigned to 4 groups (each group 30) with the calculi diameter range from 0.5 to 1.1 cm.All patients performed extracorporeal shock wave lithotripsy (X ray oriented).The control group did not accept any medical treatment.The solifenacin group were administered solifenacin 5 mg,once per day.The tamsulosin group were administered tamsulosin 0.2 mg,once per day.The combination group were administered solifenacin 5mg,plus tamsulosin 0.2 mg,each per day.The observation duration was set at 2 weeks. Results The stone-free rate (according to KUB) within 2 weeks were 80.0％,83.3％,93.3％ and 96.7％ in the control group,solifenacin group,tamsulosin group and combination group respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The stone expulsion times were (7.6 + 3.7) d,(6.3 ± 2.5) d,(4.4 + 2.3) d and (3.5 ± 2.2) d in the 4 groups respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The uses of analgesics were 13,5,9 and 3 in the 4 groups respectively.The bladder irrtative symptoms were 12,6,4 and 4 in the 4 groups respectively.Statistical differences were also significant for the use of analgesics and relief of bladder irritation between the solifenacin group,the combination group and the control group. Conclusions Tamsulosin and solifenacin could be safe and effective for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy.It could significantly improve the stone expulsion rate,relief the pain and improve bladder irrtative symptoms. Key words: Distal ureteral calculi; Tamsulosin ; Solifenacin

Efficacy of three different alpha 1-adrenergic blockers and hyoscine N-butylbromide for distal ureteral stones

To evaluate hyoscine N-butyl bromide (HBB) and three different alpha-1 blockers in the treatment of distal ureteral stones. A total of 140 patients with stones located in the distal tract of the ureter with stone diameters of 5 to 10mm were enrolled in the present study and were randomized into 4 equal groups. Group 1 received HBB, Group 2 received alfuzosin, Group 3 received doxazosin and Group 4 received terazosin. The subjects were prescribed diclofenac injection (75 mg) intramuscularly on demand for pain relief and were followed-up after two weeks with x-rays of the kidneys, ureters, bladder and urinary ultrasonography every week. The number of pain episodes, analgesic dosage and the number of days of spontaneous passage of the calculi through the ureter were also recorded. The average stone size for groups 1, 2, 3 and 4 was comparable (6.13, 5.83, 5.59 and 5.48 mm respectively). Stone expulsion was observed in 11%, 52.9%, 62%, and 46% in groups 1, 2, 3 and 4 respectively. The average time to expulsion was 10.55 ± 6.21 days in group 1, 7.38 ± 5.55 days in group 2, 7.85 ± 5.11 days in group 3 and 7.45 ± 5.32 days in group 4. Alpha blockers were found to be superior to HBB (p < 0.05). Medical treatment of distal ureteral calculi with alfuzosin, doxazosin and terazosin resulted in a significantly increased stone-expulsion rate and decreased expulsion time when compared with HBB. HBB seems to have a negative effect on stone-expulsion rate.

A Multicenter, Randomized, Controlled Trial of Transureteral and Shock Wave Lithotripsy—Which is the Best Minimally Invasive Modality to Treat Distal Ureteral Calculi in Children?

Since there is insufficient evidence to determine the best treatment modality in children with distal ureteral calculi, we designed a multicenter, randomized, controlled trial to evaluate the efficacy and complications of transureteral and shock wave lithotripsy in these patients. A total of 100 children with distal ureteral calculi were included in the study. Of the patients 50 were randomized consecutively to undergo shock wave lithotripsy using a Compact Delta II lithotriptor (Dornier MedTech, Kennesaw, Georgia), and 50 were randomized to undergo transureteral lithotripsy with holmium laser and pneumatic lithotriptor between February 2007 and October 2009. Stone-free, complication and efficiency quotient rates were assessed in each group. Mean +/- SD patient age was 6.5 +/- 3.7 years (range 1 to 13). Mean stone surface was 35 mm(2) in the transureteral group and 37 mm(2) in the shock wave lithotripsy group. Stone-free rates at 2 weeks after transureteral lithotripsy and single session shock wave lithotripsy differed significantly, at 78% and 56%, respectively (p = 0.004). With 2 sessions of shock wave lithotripsy the stone-free rate increased to 72%. Efficiency quotient was significantly higher for transureteral vs shock wave lithotripsy (81% vs 62%, p = 0.001). Minor complications were comparable and negligible between the groups. Two patients (4%) who underwent transureteral lithotripsy sustained a ureteral perforation. In the short term it seems that transureteral and shock wave lithotripsy are acceptable modalities for the treatment of distal ureteral calculi in children. However, transureteral lithotripsy has a higher efficacy rate when performed meticulously by experienced hands using appropriate instruments.

Ureteroscopic management of lower ureteric calculi: a 15‐year single‐centre experience

To review our 15-year experience with ureteroscopic treatment of distal ureteric calculi and to determine the impact of improved technology and techniques on the efficacy, success and complications of the procedure. We retrospectively reviewed the medical records of 4512 patients who underwent 5133 ureteroscopic procedures for the treatment of distal ureteric calculi at our institution from January 1991 to December 2005. The patient and stone characteristics, treatment variables and clinical outcomes were assessed. Factors such as type of ureteroscope, procedure duration, procedure success, complication rate and hospital stay were evaluated. Data obtained from a cohort of patients that underwent the procedure from 1991 to 1995 (group 1) were statistical compared with those obtained from a cohort of patients from 1996 to 2005 (group 2). Logistic regression analysis was used to identify associated factors with the major complications of ureteroscopy. Overall, the stone-free rate after the procedure was 94.6%, the mean (sd; range) operative duration was 43 (15.0; 25-120) min, the intraoperative complication rate was 6.67%, the postoperative complication rate was 9.9%, and the mean (sd) hospital stay was 1.7 (1.1) days. The clinical and radiological follow-up (mean 36.8 months) for 71.3% of eligible patients detected only 12 ureteric strictures (0.23%). On comparing group 1 with group 2, the overall success of ureteroscopic stone extraction improved from 85.7% to 97.3% (P < 0.001), significant ureteric perforation decreased from 3.3% to 0.5% (P = 0.05), ureteric avulsion decreased from 1.3 to 0.1% (P < 0.05), ureteric stricture decreased from 0.7% to 0.1% (P < 0.007), the mean (sd) procedure time significantly decreased from 75 (42.9) min to 36.5 (12.5) min (P < 0.001), and the mean hospital stay significantly decreased from 2.5 (1.6) days to 0.5 (1.2) days, with a trend toward outpatient treatment. Logistic regression analysis showed a significant association of the major ureteroscopic complications with increased operative duration, type of ureteroscope used, stone impaction, stone size and surgeon experience. The present series shows the high success rate, with minor complications, that can be achieved with ureteroscopic treatment of distal ureteric calculi. Improvements in ureteroscope design, accessories, technique and experience have led to a significant increase in the success rate and decrease in the complication rate.

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

We compared the efficacy of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) for the treatment of distal ureteral calculi with respect to patient satisfaction. This is a prospective study where a total of 212 patients with solitary, radiopaque distal ureteral calculi were treated with ESWL (n = 92) using Dornier lithotriptor S (MedTech Europe GmbH) or URS (n = 120). Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. The 2 groups were comparable in regard to patient age, sex, stone size, and side of treatment. The stone-free status for ESWL and URS at 3 months was 81.5% and 97.5%, respectively (p < 0.0001). In addition, 88% of patients who underwent ESWL versus 20% who underwent URS were discharged home the day of procedure. Minor complications occurred in 3.3% and 8.3% of the ESWL and URS groups, respectively (p = 0.127). No ureteral perforation or stricture occurred in the URS group. Postoperative flank pain and dysuria were more severe in the URS than ESWL group, although the differences were not statistically significant (p = 0.16). Patient satisfaction was high for both groups, including 94% for URS and 80% for ESWL (p = 0.002). URS is more effective than ESWL for the treatment of distal ureteral calculi. ESWL was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was significantly higher for URS according to the questionnaire used in this study.