The effect of alternating bidirectional approach during shock wave lithotripsy for upper lumbar ureteric stones. A randomized controlled trial (original) (raw)
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World Journal of Urology, 2020
Purpose To compare the outcome of shock wave lithotripsy (SWL) for upper lumbar ureteric stones using the alternating bidirectional approach versus the standard approach during the first session. Methods Our study was a randomized controlled trial including patients with single radio-opaque stone < 1 cm located in the upper lumbar ureter (from the ureteropelvic junction till the level medial to the lower margin of the kidney). SWL was conducted using electromagnetic Dornier Gemini Lithotripter. In group 1, patients were treated with the alternating under and over-table approach during the first session only and if other sessions were needed, the standard under-table approach was used. In group 2, patients were treated with the standard under-table approach during all sessions. Stone disintegration after the first session was assessed by kidney-ureter-bladder X-ray, renal ultrasonography and noncontrast computed tomography. Moreover, the incidence and severity of postoperative complications were evaluated. Results Forty-eight patients in each group completed the study. Patient demographics and stone characteristics were comparable in both groups. Complete disintegration was achieved in 41.7% of patients in group 1 versus 18.8% in group 2 (P = 0.021). Stone-free rate (SFR) was 58.3% and 20.8% in group 1 and 2 respectively (P = 0.001). The mean session time was 56.42 min in group 1 versus 46.35 min in group 2 (P < 0.001). There was no significant difference in postoperative complications. Conclusion Stone disintegration and SFR after the first SWL session are higher when using the alternating bidirectional approach for upper lumbar ureteric stones at the expense of longer procedural duration. Trial registration ClinicalTrials identifier (ID: NCT03243682), clinicaltrials.gov
The Egyptian Journal of Hospital Medicine, 2018
To compare the efficacy, cost effect and safety of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) for distal ureteric calculi by evaluating stone-free rates, retreatment rates, need for auxiliary procedures, associated complications and technical consideration with respect to patient satisfaction. Patient and method: 70 patients with single unilateral radiopaque distal ureteric stone ranges from 0.8 cm to 1.2 cm in diameter and ≥1.5 cm in length were enrolled in a prospective randomized trial. Patients were randomized to undergo URS (35) or ESWL (35). The electromagnetic Dornier lithotripter S was used for ESWL and a semi-rigid Olympus ureteroscope, 7° direction of view, angled ocular,8.6/9.8 Fr. x 43 cm, 6.4 Fr. channel was used for URS. Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. Results: Patients in the ESWL group achieved a 77.1% overall stone-free rate (SFR) with a 74.3% retreatment rate and no auxiliary procedure was done. Complications occurred in 11.4% of patients treated with ESWL. Patients in the URS group achieved a 97.1% overall SFR with a retreatment rate of 8.6% and an auxiliary procedure rate of 100%. Complications occurred in 31.4% of patients treated with URS. Patient satisfaction was high for both groups, including 94.3% for URS and 77.1% for ESWL. ESWL were already at outpatient clinic so there were no admission or hospital stay. While in URS group patients admitted with mean hospital stay 1.6±0.5 day. Conclusions: In the treatment of large distal ureteral calculi ≥ 1.5 cm, both URS and ESWL modalities are comparable but URS is recommended as a first option as it is more effective than ESWL regarding stone-free rate and it provides immediate stone clearance with lower retreatment rates and higher patient satisfaction.
Nephro-Urology Monthly, 2012
A review of the related medical journals indicates that there is no definite evidence-based option for managing large proximal ureteral stones, although many procedures such as transureteral lithotripsy (TUL), shock wave lithotripsy (SWL), percutaneous nephrolithotripsy, laparoscopic ureterolithotomy, and open ureterolithotomy are currently used to treat this urological problem. Objectives: In this study, we tried to determine the most appropriate treatment plan for proximal ureteral stones larger than 12 mm by comparing the two most commonly used procedures. Patients and Methods: Between February 2005 and April 2011, 62 patients including 40 males and 22 females (mean age 39.5 years, range 19 to 64) with proximal ureteral stones larger than 12 mm (12-26 mm) with a mean size of 17.64 mm were prospectively divided into two groups consisting of 32 patients who underwent TUL (group A) and 30 who underwent SWL (group B). In unsuccessful cases, repeat SWL or TUL was planned. Patients who could not tolerate the lithotomy position, younger than 18 years, had undergone coagulopathy, had concurrent renal and ureteral stones, were pregnant, or had sepsis were excluded from this study. Results: Stone access was successful in 28 patients and the treatment was efficient in 18 patients (56.25%) in group A. For the patients with successful stone access but unsuccessful TUL, a DJ was inserted and a second ureteroscopic intervention was performed. The second intervention was successful in 7 patients (21.87). SWL was successful in 14 patients (46.66%) in the first attempt and in 7 additional patients in the second intervention (23.33%). Conclusions: In this study, we showed different success rates for SWL and TUL because of the larger size of the stones. We achieved a success rate of 56.25% in the first attempt in the TUL group, and the overall success rate (after the second TUL) was 78.12%. In comparison, the SWL group had a success rate of 46.66% in the first attempt, and the overall success rate (after the second SWL) was 69.96%.
European Urology, 2004
Objective: The fluoroscopic image from the second plan (oblique) tube of an upper ureteral stone close to the crista iliaca may be superimposed on the pelvic bones during SWL using the Siemens Lithostar 1 with the patient in the prone position. This creates difficulty in imaging and targeting of the stone and can necessitate using ureteral catheters before treatment and/or intravenous contrast injection during SWL. We describe a very simple, yet effective method for easier visualization of the stone under this circumstance. Methods: Between March 1992 and February 2003, we treated 1561 patients with ureteral stones by SWL with the Siemens Lithostar. The stones were localized in the upper ureter in 841. The image of the stone from the second plan (oblique) tube was superimposed on the pelvic bones in 221 in whom visualization of the stone was hardly possible with the standard prone position. By simply rotating the patient 180 degrees on the table, the superimposition of the image of the stone on the pelvic bone was obviated. This resulted in easier and better imaging of the stone during SWL. It also allowed for a clear and superior image to the treating physician during SWL. The energy and shock waves, utilization of anesthesia, number of treatment sessions, auxiliary measures, and complications were noted. Stone load was recorded in square centimeters (cm 2). Patients were evaluated by intravenous urogram or KUB and ultrasonography when stone-free or CIRF (nonobstructive and noninfectious insignificant fragments 4 mm) status was noted at the fluoroscopic control 2 to 4 weeks after the last session. Final CIRF decision was made 10-12 weeks after the last session. SWL was regarded as failure if no fragmentation was noted after the 3rd session. Therapy was continued if fragmentation was noted. Results: The median age was 40 (range 5-85). The mean stone burden was 0.8 (range 0.24-2.9) cm 2. No indwelling ureteral stents were placed in any patients before and during treatment. The mean number of shock waves and energy used for the entire patient population was 2007 and 17.5 kV, respectively. The median and average treatment session was 1 and 1.7, respectively. A total of 196 patients (89%) were rendered stone-free. Clinically insignificant residual fragments were present in 18 (8%). SWL was unsuccessful in 7 (3%) patients. These stones were removed by ureterorenoscopy. Intravenous contrast administration was not used to facilitate stone targeting during SWL. Anesthesia, in the form of analgesic sedation, was used in 7 (3%) patients. We did not observe any complications and adverse effects. Conclusions: The technique described hereby does not have an affect on coupling; it only provides a superior image of the stone to the treating physician. We advocate its application in all patients with upper ureteral stones close to
World Journal of Urology, 2018
Introduction A rising incidence of kidney stone disease has led to an increase in ureteroscopy (URS) and shock wave lithotripsy (SWL). Our aim was to compare the cost of URS and SWL for treatment of stones. Methods A systematic review and meta-analysis based on Cochrane and PRISMA standards was conducted for all studies reporting on comparative cost of treatment between URS and SWL. The cost calculation was based on factual data presented in the individual studies as reported by the authors. English language articles from January 2001 to December 2017 using Medline, PubMed, EMBASE, CINAHL, Cochrane library and Google Scholar were selected. Our study was registered with PROSPERO (International prospective register of systematic reviews)-registration number CRD 42017080350. Results A total of 12 studies involving 2012 patients (SWL-1243, URS-769) were included after initial identification and screening of 725 studies with further assessment of 27 papers. The mean stone size was 10 and 11 mm for SWL and URS, respectively, with stone location in the proximal ureter (n = 8 studies), distal ureter (n = 1), all locations in the ureter (n = 1) and in the kidney (n = 2). Stone free rates (84 vs. 60%) were favourable for URS compared to SWL (p < 0.001). Complication rates (23 vs. 30%) were non-significantly in favor of SWL (p = 0.11) whereas re-treatment rates (11 vs. 27%) were non-significantly in favor of URS (p = 0.29). Mean overall cost was significantly lower for URS ($2801) compared to SWL ($3627) (p = 0.03). The included studies had high risk of bias overall. On sub-analysis, URS was significantly cost-effective for both stones < 10 and ≥ 10 mm and for proximal ureteric stones. Conclusion There is limited evidence to suggest that URS is less expensive than SWL. However, due to lack of standardization, studies seem to be contradictory and further randomized studies are needed to address this issue.
Prediction of success of extracorporeal shock wave lithotripsy in the treatment of ureteric stones
International Urology and Nephrology, 2007
Objectives To define the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureteric stones. Patients and methods Between January 2000 and December 2003, 468 patients with ureteric stones underwent in situ ESWL using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones. Characteristics of the patients, condition of the urinary tract and stone features were correlated to the success rate to define the significant predictors of success. Results At 3-month follow-up, the overall success rate was 394/468 (84.2%). Repeat treatment was required in 239 patients (51.1%). Post-ESWL auxiliary procedures were necessary in 58 patients (12.4%). Post-ESWL complications were observed in 11 patients (2.4%). Only three factors had a significant impact on the stone-free rate, namely stone site, stone width and the presence of a ureteral stent. The stone-free rate was highest for stones located in the lumbar ureter (159/183; 86.9%) and lowest for those in iliac ureter (28/40; 70%) (P < 0.05). Stones with a transverse diameter < 8 mm were associated with a stonefree rate of 89.9% (248/276), compared to 66.7% (128/192) for those with a transverse diameter of >8 mm (P < 0.01). Non-stented patients had a stone-free rate of 89.2% (313/348), compared to 75.2% (85/113) for stented patients (P < 0.01). Conclusions The site and transverse diameter of the stone and the presence of a ureteral stent are the only significant predictors of success of ESWL therapy for ureteric stones.
Urology, 2005
Objectives. To compare the safety and cost-effectiveness of ureterorenoscopic holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy (URSL) with extracorporeal shock wave lithotripsy (ESWL) for proximal ureteral stones. Methods. This investigation assessed 220 patients with upper ureteral stones. Those in the ESWL group were treated on an outpatient basis using the Medispec Econolith 2000 (Medispec, Germantown, Md) under intravenous sedation. URSL was performed with a 6/7.5F semirigid tapered ureterorenoscope and holmium: YAG laser under spinal anesthesia on an inpatient basis. A successful outcome was defined as the patient being stone free on radiography 1 month after treatment. The stone size, success rate, postoperative complications, and cost were evaluated in each group. Results. A total of 220 patients were enrolled in this study. Hematuria and flank pain were the most common complaints in each group. The mean stone burden Ϯ SD was 58.7 Ϯ 3.1 mm 2 in the ESWL group and 108.4 Ϯ 10.0 mm 2 in the URSL group (P ϭ 0.000). The accessibility of the semirigid ureterorenoscope for upper ureteral stones was 98.1% (101 of 103), and the stone-free rate achieved after one treatment was 83.2% (84 of 101). The initial stone-free rate of in situ ESWL was 63.9% (76 of 119). Significantly, the initial stone-free rate of the URSL group was superior to that of the ESWL group (P ϭ 0.001). The average cost in the URSL group appeared to be lower than that in the ESWL group (P ϭ 0.000). Conclusions. The results of this study have demonstrated that URSL achieved excellent results for upper ureter calculi. In terms of cost and effectiveness, this procedure should be the first-line therapy for proximal ureter stones. UROLOGY 65: 1075-1079, 2005.