Treatment Of Upper Ureteral Stones Research Articles

A Comparison of Ureterorenoscopy and Extra-Corporeal Shock Wave Lithotripsy for the Treatment Of Upper Ureteric Stone Measuring Less than 1cm.

Objective: To compare the efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS) in the management of upper ureteric stone measuring <1cm. Methodology: Randomized clinical trial (RCT) was conducted by targeting the patient admitted in urology ward, Jinnah Hospital Lahorethrough a period of one year. A sample size of 132 patients fulfilling inclusion criteria were selected by employing Non-probability consecutive sampling technique was employed to select 132 (sample size) patients fulfilling inclusion criteria. Patients were randomly allocated into two groups (66 in each group A&B) using lottery method. In group-A, stones were treated using ESWL, while in group-B, URS was performed, and stones were broken with pneumatic energy. Data were analyzed using SPSS version 27, and a Chi-square test was conducted to compare the proportions of qualitative variables, while an independent sample t-test was applied to assess mean differences between two groups of quantitative variables. Asignificance level of ≤0.05 was adopted for determining statistical significance. Results: The sociodemographic profile of the two groups was comparable. It was seen that stone free rate nextto first session was higher in URS (81.8%) as compared to ESWL (63.6%) which later increased to 87.7% after completion of three session. The complaint of pain in ESWL was more as compared to URS (22.7% vs 12.1% p= 0.05)while the differences betweenthe rate of complications like fever, UTI, mucosal abrasion, hematuria or perforation were not statistically significant in both group. (p> 0.05) Conclusion: ESWL outperforms URS for the treatment of upper ureteric stones measuring <1cm in terms of efficacy and safety.Although not statistically significant, ourfindings suggest that URS achieves stone-free rates earlier than ESWL. However, according to our findings, ESWL is recommended as the treatment of choice for the majority of patients due to better compliance. Keywords: Extra-corporeal Shock Wave Lithotripsy, Nephrolithiasis, Ureterorenoscopy

Analysis of the Efficacy of Flexible Ureteroscopy and Rigid Ureteroscopy with Holmium Laser Lithotripsy in the Treatment of Upper Ureteral Stones in the Elderly

Objective: To compare the clinical efficacy of rigid ureteroscopy and flexible ureteroscopy with holmium laser lithotripsy in elderly patients with upper ureteral stones. Methods: 12 elderly cases of upper ureteral stones were selected and divided into two groups according to the type of surgery. The control group and the observation group adopted rigid ureteroscopic holmium laser lithotripsy and flexible ureteroscopic holmium laser lithotripsy, respectively. General observation indicators, laboratory indicators, and short-term efficacy-related indicators of surgery were compared between the two groups. Results: The operation time, ambulation time, and hospitalization time of the observation group were shorter than those of the control group, and the intraoperative blood loss was less than that of the control group (P < 0.05). There was no significant difference in the total primary/secondary stone clearance rate, postoperative complications, and disease recurrence rate after six months of follow-up in the two groups (P > 0.05). Conclusion: Compared with rigid ureteroscopic holmium laser lithotripsy, flexible ureteroscopic holmium laser lithotripsy for elderly patients with upper ureteral stones is more conducive to shortening the treatment and postoperative recovery time, and simultaneously, it causes no severe complications and is worthy of promotion.

A Comparative Analysis between Flexible Ureteroscopic Lithotripsy and Tubeless Percutaneous Nephrolithotomy in the Treatment of >15 mm Non-Obstructing Proximal Ureteral Stones.

The proper surgical modality for large non-obstructing proximal ureteral stones is disputed. We compare effectiveness and safety of flexible ureteroscopic lithotripsy (FURL) and tubeless percutaneous nephrolithotomy (TPNL) in treatment of upper ureteral stones larger than 1.5 cm. We reviewed the medical records of patients who performed FURL or TPNL for upper ureteral stones between June 2016 and November 2018. Comparative analysis was conducted regarding demographic parameters, stone free rate, postoperative pain and complications. This study included 58 patients treated with FURL and 60 patients treated with TPNL owing to upper ureteral stones larger than 1.5 cm. Stone size was similar in the FURL and TPNL groups (17.6 ± 2.6 vs. 18.0 ± 2.1 mm, p = 0.194). The overall 3-month stone clearance rate was 95.8% for FURL versus 96.0% for TPNL (p = 0.575). There was no difference between the FURL and TPNL groups for hospital stay (p = 0.280) and postoperative complications. On the other hand, patients treated with FURL had longer operative time (p = 0.012) and less postoperative pain (p = 0.008). Both surgical techniques were considered feasible and effective surgical procedures in the treatment of large upper ureteral stones.

Where is it logical to break-up a ureter stone with endoscopic surgery?

Background/Aim: Today, we have the technology to break up a ureter stone in the ureter, as well as in the renal pelvis, with ureterorenoscopic procedures. In the past, when this option was not available, the surgeons improved several techniques and antiretropulsion devices to let the stone migrate through the renal pelvis. This study was conducted to clarify whether it is more advantageous to dust a stone in the ureter where it is impacted or in a wider area such as the renal pelvis. Methods: The data of 134 patients who underwent semirigid ureterorenoscopy (srURS) due to single and primary upper ureteral stones were included and analyzed in this retrospective cohort study. The patients were divided into two groups according to the development of spontaneous push-up during surgery (Group 1: The non-push-up group, Group 2: The push-up group). Results: While hemoglobin levels lowered significantly in both groups after the surgery, creatinine levels increased (P 0.05). Operation times were similar in both groups, in contrast with the literature. Stone-free rates were significantly higher in srURS than in intrarenal surgery (RIRS) (P=0.03). Complication rates were also similar in this study. Conclusion: The application of srURS after fixing an upper ureter stone at its location using a Stone Cone® results in higher stone-free rates than pushing it back to dust it in renal pelvis. We recommend srURS supported by an antiretropulsion method as a treatment for upper ureteral stones.

Evaluation of Ureterorenoscopy with Semirigid Ureteroscope and Laser Lithotripsy as a Treatment Modality for Upper Ureteric Stones Less Than 20 mm

Context: Technological developments over the past two decades have revolutionized the treatment of ureteric stones. With the emergence of flexible, small-diameter ureteroscopy, the paradigm of ureteral stone treatment has shifted to ureteroscopy. The success rate is close to 95%, but it has its own complications. Objective: The objective of this study is to assess the effectiveness of ureterorenoscopy (URS) with semirigid ureteroscope and laser lithotripsy in the treatment of upper ureteric stones of size less than 20 mm and its associated complications. Methods: This is a prospective cohort study designed to assess the effectiveness of URS for the treatment of upper ureteric calculi. We present data from 57 patients who received URS as their primary treatment at our center and were followed up for at least 3 months. Results: We found that when stone size was less than 10 mm, the stone-free rate was 80% (28/35), while when stone size was in the 10.1–20 mm range, the stone-free rate increased to 90.9% (20/22). Stones were found in 41/48 patients (85.41%) with symptoms lasting less than a month. Only 7/9 patients (77.77%) were stone-free in the group with symptoms lasting more than a month. A total of 28.1% of patients encountered complications among which proximal migration of the stone was the most common (12.3%). Mean procedure time was 40.37 min. Conclusion: This study shows that URS had a higher stone-free rate when treating stones of size ranging from 10.1 to 20 mm. In upper ureteric stones ranging in size from 10.1 to 20 mm, we strongly advise using URS as the primary treatment option.

Micro-ureteroscopy (m-URS) for treatment of upper ureteral stones in children: A new, different approach.

Micro-ureteroscopy (m-URS) for treatment of upper ureteral stones in children: A new, different approach.

Value of early second session shock wave lithotripsy in treatment of upper ureteric stones compared to laser ureteroscopy.

The safety and efficacy of early second session shock wave lithotripsy (SWL) compared with laser ureteroscopy (URS) for the treatment of upper ureteric stones were evaluated. From January to October 2019, 108 patients with upper ureteric stones (< 1.5cm and ≤ 1000 Hounsfield unit (HU)) were randomized into SWL and laser URS groups. The second SWL session was performed within 48-72h of the first session. Using plain abdominal X-ray and ultrasonography, patients were evaluated 48-72h after the first SWL session and one week after the second and third SWL sessions or one week after URS. The procedure was considered a success when no additional procedures were needed to clear the stone. To determine the stone-free rate (SFR), noncontrast computed tomography of the urinary tract was performed three months postoperatively. In the SWL group, the success rates were 92.6% and 94.4% after the second and third sessions. The SFR was 96.2% in the laser URS group. The success rates were not significantly different between the second and third SWL sessions versus the laser URS (p = 0.418 and 0.660, respectively). Operative and fluoroscopy times were significantly longer in the SWL group (p = 0.001), and JJ stent insertions were needed after laser URS. Ultraslow full-power SWL treatment of patients with upper ureteric stones (< 1.5cm and ≤ 1000 HU) with an early second session is safe and effective compared to laser URS. Patients who do not respond to early second SWL session should be shifted to another treatment modality.

Extracorporeal Shockwave Lithotripsy with Tamsulosin in Clearance of Upper Ureteral Calculi- A Randomized Control Clinical Trial

Background of the study: Urolithiasis has an incidence in the world of about 5% and the probability of a recurrence within 5–7 years is 50% (Parmar, 2004). Exact data about its prevalence is not known in Bangladesh but it is quite common as seen in outpatient department. It is more common in northern part of the country, male suffer more than female (M:F: 3:1) (Salam, 2002). Symptomatic ureteral calculi represent the most common condition encountered by an urologist in an emergency setting (Pak, 1998). Intervention is recommended for individuals with larger stones, especially greater than 5 mm (Kupeli et al., 1998). The treatment of this pathology was revolutionized with the introduction, in the late 1980s, of extracorporeal shock wave lithotripsy (ESWL), a non-invasive technology that has become one of the primary treatments for urinary stones. Its success rates vary depending on stone size and location and by the type of lithotripter employed. Medical expulsion therapy (MET) can play a key role in support of ESWL: specifically, expulsion is done by diuretics, calcium antagonists, anti-edema agents, and alpha-blockers. A few studies have reported their effectiveness (Borghi et al., 1994, Cervenakov et al., 2002, Porpiglia et al., 2002,Dellabella et al., 2003). Objective: This study is carried out to find out the role of Tamsulos in stone clearance in patientswith upper ureteral stone after extracorporeal shock wave lithotripsy (ESWL). Methods &amp; Material: This randomized control clinical trialwas performed in Department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBangla Nagar, Dhaka during the period from July 2015 to June 2017. A total of 70 cases with upper ureteric stone were included during the study period. Patients were selected randomly in every alternate sequence, odd numbers for experimental group, Tamsulosin+ ESWL, group A &amp; even numbers for control group, only ESWL, group B. Stone clearance rate, number of ESWL session and stone expulsion time were evaluated. Results: In this study showed complete stone clearance one month after ESWL in Group A was 16(89%) and Group B was 16(84.21%) for stone size 6 to 10 mm. Comparison of clearance rate between two groups in stone size 6 to 10 mm was not statistically significant (p value &gt;.05). Complete stone clearance one month after ESWL in Group A was 13(76%) and Group B was 07(43.75%) for stone size 11 to 15 mm. Comparison of clearance rate between two groups in stone size 11 to 15 mm was statistically significant (p value &lt;.05). In this study requirement of number of ESWL sessions according to the stone size showed, in case of 6 to 10 mm stone size, average ESWL sessions 1.28±0.5 in Group A and 1.53±0.7 in Group B and in case of 11to 15 mm stone size, average ESWL sessions 1.29±0.5 in Group A and 1.62±0.7 in Group B. Comparison of ESWL sessions between two groups were statistically significant (p value &lt;.05). In this study mean expulsion time of stone in Group A was 22.34±12.23 days and in Group B was 32.34±21.96 days. Comparison of stone expulsion time between two groups were statistically significant (p value &lt;.05). Conclusion: Tamsulosin results in increased stone-free rates and in lower percentages of patients requiring re-treatment. Tamsulosin can be self-administered and can play a key role in the choice between tamsulosin after ESWL and only ESWL for upper ureteric stone disease treatment. Use of tamsulosin makes the expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for upper ureteral stones. Tamsulosin helps in clearance of upper ureteral stones after ESWL. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.36-42

Testing the New Parameters affecting The Outcome of Extracorporeal Shockwave Lithotripsy for Upper Ureteric Stones

Background: Extracorporeal Shock wave lithotripsy (ESWL) is widely used in treating patients with ureteralstones because it is effective, safe, and noninvasive. Based on factors such as size and the location of stones,there is a significant variation in the overall stone-free rate (SFR).Aim of the study: To evaluate the effect of ureteral wall thickness (UWT), stone attenuation, the time fromfirst attack of pain till first session of ESWL and stone/ rib density on the outcome of SWL in the treatmentof upper ureteral stones (UUS).Patient and methods: A prospective study when 127 patients with radio-opaque UUS ranging from 7 to 20mm and treated by ESWL were included in this study. The effect of (stone/ 12th rib) density by KUB, ureteralwall thickness by NCCT and the time from first attack of pain till first ESWL session was studied.Results: The overall successful fragmentation was 75.5%, with the overall success rates in the low density(LD) and high density (HD) groups were 83.8% and 52.94%, respectively. The average number of SWLsessions needed in the two groups for success was 1.9 compared with 2.7 sessions (p&lt;0.05). For stones &lt;10 mm; those with ureteral wall thickness &lt;3.25 mm have success rate about 90.3% VS 69.7% with uretericwall thickness &gt; 3.25 mm which is highly significant. Early ESWL within the first 24 hours of acute attackof first pain has successful fragmentation of 85.45%. With significant effect on number of ESWL sessions.The stone free rate reaches 91.1% for stones &lt;10 mm.Conclusions: The stone free rate is inversely affected by stone /12th rib density ; ureteral wall thickness andthe time from first attack of pain till first session of ESWL, were important predictors of successful ESWL.

Shockwave Lithotripsy Is an Efficacious Treatment Modality for Obese Patients with Upper Ureteral Calculi: Logistic Regression and Matched-Pair Analyses from a Dedicated Center Comparing Treatment Outcomes by Skin-to-Stone Distance.

Objectives: To assess the association of skin-to-stone distance (SSD) and stone-free rates following extracorporeal shockwave lithotripsy (SWL) using two statistical methods: logistic regression and a matched-pair analysis approach. Patients and Methods: Patients with a solitary radio-opaque upper ureteral calculus diagnosed on noncontrast computed tomography were included. Patients were treated with a Sonolith I-Sys Lithotripter (focal depth 17 cm). Stone treatment success was defined as stone free (fragments ≤3 mm) at 3 months. Failure was defined as persistent fragments beyond 3 months or requirement for intervention with ureteroscopy. The outcome was assessed by a plain kidney, ureter, and bladder radiograph (KUB) at 2 weeks. Logistic regression was used to determine association of patient and stone factors with treatment failure. The patient cohort was divided into tertiles by SSD, and matched-pair analysis was undertaken between individuals from the top and bottom tertiles (SSD ≤12 cm and SSD ≥14 cm). Matching criteria consisted of age, sex, maximum stone diameter (±2 mm), and stone density (±250 HU). Results: From a database of 2849 patients who underwent SWL, 397 patients were identified who had treatment of a single upper ureteral stone. Age (odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.01-1.04, p = 0.007), SSD (OR: 1.16, 95% CI: 1.03-1.32, p = 0.02), stone side (OR: 1.65, 95% CI 1.01-2.73, p = 0.05), stone diameter (OR: 1.09, 95% CI: 1.00-1.19, p = 0.05), and multiple sessions (OR: 4.65, 95% CI: 2.61-8.29, p < 0.001) were significantly associated with treatment failure by logistic regression univariable analysis. Multiple sessions was the only factor significantly associated with treatment failure on multivariable analysis (OR: 4.03, 95% CI: 2.18-7.42, p < 0.001). From a cohort of 141 patients with SSD ≥14 cm and 174 patients with a SSD ≤12 cm, 66 matches were identified (132 patients). Forty-nine patients (74.2%) with SSD ≥14 cm were deemed stone free at follow-up vs 51 patients (77.3%) with SSD ≤12 cm (p = 0.85). Conclusion: This study demonstrates by two statistical methods that SWL can provide efficacious treatment of upper ureteral stones in obese patients and that the upper threshold of SSD for SWL with Sonolith I-SYS could be revised to allow these patients the benefits of SWL.

Semi-rigid Ureteroscopy and Holmium laser stone dusting for Proximal Ureteral Stones Does Adjuvant Tamsulosin Therapy Increase the Chance of Success?

Abstract Background Alpha blockers decrease peristalsis above and below the stone, which increases the urine bolus and intraureteral pressure above it and lowers intraureteral pressure below it in association with the decrease in basal and micturition pressure, even at the bladder neck; thus, it increases the chance of stone expulsion.We aim to evaluate whether peri-operative tamsulosin in stented ureteroscopic laser lithotripsy for proximal ureteric stones increase the procedure success rate of stone clearance. Since our aim in ureteroscopic treatment of upper ureteric stones is laser dusting rather than stone retrieval, its possible that alpha blockers can improve the access to upper ureter and clearance of fragmented stones. Objective To evaluate whether peri-operative tamsulosin in stented ureteroscopic laser lithotripsy for proximal ureteric stones increase the procedure success rate of stone clearance. Patients and Methods This prospective, randomized, multicenter study included 60 patients and carried out between March 2018 and December 2018 in Police hospital Nasr City and Ain Shams University Hospitals included adult patients (at least 15 years) with proximal ureteral stones (≥ 5mm) scheduled for URS lithotripsy. Results In this study, the overall failure rate was 18.3%. In most cases 8/11(72.7%), failure of the procedure was due to the difficulty experienced in advancing the ureteroscope. We should mention that this technical problem was reported only in 2 (6.7%) patients receiving pre-URS tamsulosin but in 6 (20%) patients of the control group. The mean operative time in this series was significantly shorter operative time in Group 2(51.8min) compared to Group 1(58.8 min).At follow-up 4 weeks after URS, SFR was (86.7% for Group 2 and 66.7% for Group 1). Conclusion Adjunctive tamsulosin therapy prior to laser-assisted semi-rigid URS for the management of proximal ureteral stones improves ureteroscopic access, reduces the operative time and improves the SFR with an acceptable complication rate. Further research should be conducted on a larger scale to evaluate the various predictors of the outcome of URS and analyze the results with different pre-URS tamsulosin time periods in order to consolidate the results and to confirm the conclusion.

Application of Intermittent Lung Inflation Combined with Rigid Ureteroscopy in Treating Upper Ureteral Stones That Were Not Fully Visible

Objective To analyze the effectiveness and safety of intermittent lung inflation combined with rigid ureteroscopy in the treatment of upper ureteral stones that were not fully visible. Methods The clinical and imaging data of 56 patients with upper ureteral stone undergoing rigid ureteroscopic lithotripsy combined with intermittent lung inflation in Zhejiang Quhua Hospital from March 2016 to October 2017 were retrospectively analyzed.Intermittentt lung inflation was used to change and stabilize the position of ureteral calculi during the operation,so as to ensure the visual field of ureteroscopy.Holmium laser lithotripsy was performed to remove the stones.Urinary tract abdominal plain X-ray or CT urography was performed 1 and 3 months after the operation to evaluate the residual stones and the clinical efficacy. Results Stones were successfully removed after a single attempt in 48 patients.In 5 patients,stones escaped into the kidney during ureteroscopic lithotripsy,and thus flexible ureteroscopy were performed.In 3 patients,a second session of auxiliary procedure was required,among whom 2 patients received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy+ureteroscopic lithotripsy.The stone-free rates 1 and 3 months after surgery were 94.6%(53/56)and 100%(56/56),respectively.No severe complication such as ureter perforation,gross hematuria,septic shock,or pneumothorax occurred during and after surgery. Conclusions Intermittent lung inflation in tracheal intubation under general anesthesia in patients with proximal ureteral stones that can not be fully visible during rigid ureteroscopic lithotripsy was feasible and reliable.It can effectively change the location of stones and thus enable safe and effective lithotripy.It expands the indications of rigid ureteroscopy for treating upper ureteral stones.

Impact of case volume per year on flexible Ureteroscopy practice: an internet based survey

BackgroundTo report current worldwide variation in techniques and clinical practice of flexible ureteroscopy (FURS) among endourologists of different case volumes per year.MethodsTwo invitations to complete an internet survey were emailed to Endourological Society members. Some of survey questions asked about indications of using FURS for renal and upper ureteral stones. Others were concerned with clinical practice of FURS (such as preoperative stenting, use of ureteral access sheath (UAS) and safety guidewire, technique of Laser lithotripsy and fragment retrieval, and post-FURS stenting. Responders were distributed into two groups; high-volume (> 100 cases/year) and low-volume surgeons (< 100 cases/year) and data were compared between both groups.ResultsResponses were received from 146 endourologists all over the world (62 high-volume and 84 low-volume). FURS for intrarenal stone > 20 mm was used by 61% of high-volume surgeons compared with 28.6% for low-volume (P < 0.001). Semirigid URS was used for upper ureteric stones in 68% among high-volume group and 82% in low-volume group (P = 0.044). UAS was used by 62% in low-volume group and 69% in high volume group (P = 0.516). Laser stone dusting was preferred by 63% in low-volume group versus 45% by high-volume (P = 0.031). More responders in low-volume group preferred to leave the stent for 6 weeks (P = 0.042).ConclusionsThe use of FURS for treating upper tract calculi has expanded by high volume endourologists to include large renal stones > 20 mm. Low-volume surgeons prefer to use semi-rigid URS for treatment of upper ureteral stones, to apply Laser stone dusting and maintain ureteral stents for longer periods.

External physical vibration lithecbole facilitating the expulsion of upper ureteric stones 1.0\u20132.0\xa0cm after extracorporeal shock wave lithotripsy: a prospective randomized trial

To observe the efficacy and safety of External Physical Vibration Lithecbole (EPVL) in patients with upper ureteric stones 1.0–2.0 cm after extracorporeal shock wave lithotripsy (ESWL). A total of 271 patients with upper ureteric stones 1.0–2.0 cm were prospectively randomized into two groups. One hundred and twenty-seven cases in the treatment group accepted EPVL therapy and 144 cases as control after ESWL. The stone expulsion status and stone-free rates (SFRs) between two groups were compared at the 1st, 2nd and 4th weekends by imaging examinations. All of 271 patients were randomly assigned to two groups, of which 127 patients were included in the treatment group and 144 in the control group. EPVL was successful in assisting the discharge of stone fragments. The rate of stone expulsion at day 1 in the treatment group was significantly higher than in the control group (79.5% vs. 64.6%, P = 0.006). The SFRs of the 1st weekend (76.3% vs. 61.8%, P = 0.010), the 2nd weekend (88.2% vs. 77.1%, P = 0.017) and the 4th weekend (92.1% vs. 84.0%, P = 0.042) in the treatment group were all significantly higher than that in the control group. However, no statistical significance was found in complications between the two groups (P > 0.05). Furthermore, in the treatment group the patients were treated a mean 4.3 sessions of EPVL. EPVL and ESWL are ideal complementary partners in the treatment of upper ureteric stones 1.0–2.0 cm, satisfying both high SFR and low complication. This method is safe and reproducible in clinical practice, and it also needs large-scale multicenter prospective studies further to prove the above conclusions.

Role of Extracorporeal Shock Wave Lithotripsy in Management of Upper Ureteric Stones

IntroductionThe treatment options for upper ureteric stones range from open surgeries to minimally invasive and non invasive techniques. Presently the two most frequently used options for upper ureteric calculi that require intervention are extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopy (URS) with contact lithotripsy applied by attaining endoscopic access to the calculi. ObjectiveThe objective of this study is meant to evaluate ESWL in the treatment of upper ureteric stones ≤2 cm in terms of stone free rates, complications and procedure time. Patients and methodSeventy six patients were subjected to ESWL as primary modality for treatment of upper ureteric stone. ESWL group had mean stone size of 10.58 mm. The stone free rate was 93.4% for ESWL. The sample size was adequate as it was determined by statistician by applying pertinent formulas. ResultsIt was observed that the stone free rate in ESWL group was higher (97.7%) when the stone size was ≤10 mm and when the duration of symptoms was <1 month. ESWL was advantageous in terms of procedural time with no requirement of anaesthesia. The complications in ESWL were minor in nature and were not statistically significant. ConclusionIn conclusion, this study shows that ESWL is an important modality in treating upper ureteric calculi ≤2 cm in size and we strongly recommend ESWL as the first choice of procedure in solitary upper ureteric calculi ≤10 mm size.

Can intervals in extracorporeal shock wave lithotripsy sessions affect success in the treatment of upper ureteral stones?

IntroductionManaging upper ureteral stones with shock wave lithotripsy (SWL) has been done for many years. However, no conclusive data have been found on the intervals required between repeated SWL sessions.AimTo identify the most optimal intervals between SWL sessions.Material and methodsBetween September 2015 and December 2016, 80 patients undergoing elective outpatient lithotripsy who required repeated SWL sessions for ureteral stones were evaluated. These patients were categorised into two groups according to different SWL session intervals. The intervals between SWL sessions (n = 40) for the first group lasted one day, whereas those for the second group (n = 40) lasted 1 week. The data recorded during SWL included visual analogue scale (VAS) scores, total number of shocks, total energy used and number of sessions. The stone clearance rates, number of urinary tract infections, complication rates and VAS scores were compared between the two groups.ResultsAll patients’ clinical outcomes after SWL therapy are shown in Table I. The stone clearance rate for group 1 was 70%, whereas that for group 2 was 72.5% (p = 0.805). Additionally, the number of urinary tract infections, complications and VAS scores were similar for both groups. In group 1, 3 patients had steinstrasse, two suffered from severe renal colic, and one had a urinary tract infection. In group 2, 3 patients endured steinstrasse, and 2 patients experienced severe renal colic during the study.ConclusionsShort-interval SWL sessions are safe and effective for treating upper ureteral stones, and such sessions do not increase complication rates.

Efficacy and safety on upper ureteric lithotripsy by Shuo Tong ureteroscopy

Objective To investigate the efficacy and safety of Shuo Tong ureteroscopy in the treatment of upper ureteric stones. Methods The data of 832 patients , who underwent Shuo Tong ureteroscopy combined with holmium laser for the treatment of upper ureteric stones were collected between July 2014 and February 2017. The patients accepted general anesthesia under lithotomy position.After dilating the ureter, a ureteral access sheath was inserted along the guide wire. Finally, stones were broken and clean up by Shuo Tong ureteroscope.According to the stone size, 823 patients were divided into ≤2.0 cm group (n=112, 13.6%), 2.1-3.0 cm group (n=395 , 48.0%), 3.1-4.0 cm group (n=257, 31.2%), >4.0 cm group (n=59 , 7.2%)The stone free rate(SFR)and post-operative complications were observed. Results Among 983 operations, 663 cases accepted one-stage operations and 160 cases accepted second stage operations. the operative time and postoperative hospital stay were 23-145 min(mean 74.8±35.3)and 1-5 days(mean 1.9±0.8), respectively. The SFR in the first day and one month after operation was 75.6% and 83.8% , respectively. The stone free rate in each group were 89.3%, 82.5%, 61.1%, 52.5% at first day after operation respectively(P<0.05). While, the SFR after one month were 95.5%, 87.6%, 72.0%, 61.0% in each group, respectively(P<0.05). Fever rate after operation was 11.1%, ureteral injury rate was 1.9%, severe hematuria rate was 0.6%, stone street formation rate was 1.2%, perirenal hematoma rate was 0.4%. All patients were improved after conventional treatment. Conclusion Shuo Tong ureteroscopy is a safe treatment with high stone free rate for upper ureteric stones. Key words: Shuo Tong ureteroscopy; Upper ureteric stones; Stone free rate; Complication

Application effect of single port laparoscopic techniques in urology grassroots

Objective To explore the application effect of single port laparoscopic techniques in urology grassroots. Methods 60 patients with upper ureteral stones were randomly divided into observation group(using single port laparoscopic technique lithotripsy) and control group (30 cases with open surgery). The surgery time, blood loss, hospital stay, postoperative complications were compared between the two groups and the patients were followed up for three months, the clearance rate of stones and patients' satisfaction were observed. Results The operative time between the two groups had no significant difference(t=1.559, P>0.05). The blood loss of the observation group was significantly less than that of the control group[(128.3±10.32)mL vs. (76.4±9.65)mL], the difference was statistically significant(t=20.003, P<0.01), and the hospitalization time was shorter than that of the control group[(5.86±1.47)d vs. (7.95±1.53)d], the difference was statistically significant(t=5.395, P<0.01). The incidence rate of postoperative complications of the observation group was lower than that of the control group(6.7% vs. 30.0%), the difference was statistically significant(χ2=5.454, P<0.05). Followed up for 3 months, the ESWL rate(73.3% vs. 96.7%) and satisfaction rate (100.0% vs. 80.0%) in the observation group and the control group had statistically significant differences (χ2=4.705, 4.629, all P<0.05). Conclusion The single port laparoscopic technique lithotripsy in the treatment of upper ureteral stones has precise effect, less invasion, high ESWL rate, low complication rate and other advantages, and it is worthy of wide promotion. Key words: Ureteral calculi; Laparoscopy; Urologic surgical procedures

423 - What are the benefits and harms of ureteroscopy (URS) compared with shock-wave lithotripsy (SWL) in the treatment of upper ureteral stones: A systematic review

423 - What are the benefits and harms of ureteroscopy (URS) compared with shock-wave lithotripsy (SWL) in the treatment of upper ureteral stones: A systematic review

Comparison of Pneumatic and Laser Lithotripsy in the Endoscopic Treatment of Upper Ureteral Stones

Comparison of Pneumatic and Laser Lithotripsy in the Endoscopic Treatment of Upper Ureteral Stones