Extracorporeal Shock Wave Lithotripsy of Distal-Ureteral Calculi: Is It Worthwhile? (original) (raw)
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Extracorporeal Shock-Wave Lithotripsy for Distal Ureteric Calculi
ANZ Journal of Surgery, 1992
Objective To compare the safety and efficacy of different approaches using ESWL for management of distal ureteric stone in an attempt to select the ideal one. Patients and methods This is a prospective randomized single-center study conducted on patients with lower third single radiopaque ureteric stone with size less than 15 mm. Patients were randomized into three groups, group A: Supine transgluteal, group B: Modified prone and group C: Prone position (80 patients each). The success of the procedure was assessed by NCCT and is defined as complete stone removal or had only clinically insignificant fragments (< 3 mm) for a maximum of three sessions. The success rate, rate of complications, pain intensity by visual pain scale and patients' satisfaction rate were compared among the three study groups. Results Data of 240 patients were analyzed (80 in each group). Overall, no significant difference has been observed among all groups regarding demographic data, stone and treatment characteristics. The overall success rates for treatment after the last session were 86.3%, 65% and 62.5% in the three study groups, respectively, with a statistically significant difference for group A. Regarding pain perception and complication rate, all groups were comparable. Patient satisfaction is significantly better in group A versus the other two groups. Conclusion Our study has confirmed better efficacy profile and patients' satisfaction rate of ESWL in the supine position (transgluteal approach) than other different known approaches for the treatment of distal ureteral stones.
International Urology and Nephrology, 2008
Objective To assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated proximal ureteral calculi and compare it to that for isolated distal calculi. Patient and methods We treated 68 patients with isolated ureteral stones using MPL 9000. Stones were located in the proximal and distal ureters in 44 and 24 patients, respectively. Patients were stratified according to stone burden and degree of obstruction. Data of all patients were prospectively collected for stone burden, stone localization, number of sessions, number of shock waves, stone-free rates (SFRs), complications, re-treatment rates and auxiliary procedures. Outcomes regarding ureteral localization were compared. Results The overall SFR was 85.3% with a 41.2% re-treatment and 17.6% auxiliary procedure rate. The mean number of shock waves applied for each stone was not different among the two ureteral locations. The SFRs were 86.3% and 79.1% for proximal and distal ureteral stones, respectively (P = 0.17). For the group with stones <100 mm 2 , the SFR was 85.4% and 89.5% for the proximal and distal ureter, respectively. Although the degree of obstruction did not affect SFR of the entire group (P = 0.12) and the proximal ureter group (P = 0.96), it adversely affected SFR in the distal ureter (P = 0.017). Conclusions ESWL outcomes for the ureteral calculi support the use of lithotripsy particularly for stones <100 mm 2 . Treatment efficacy was not significantly different among stones localized in proximal and distal ureters. Degree of obstruction did not affect the ESWL outcomes in the proximal ureter, but it adversely affected SFR in the distal ureter.
Ureteral calculi: extracorporeal shock-wave lithotripsy performed in situ on an outpatient basis
World Journal of Urology, 1992
were subjected to extracorporeal shockwave lithotripsy (ESWL) performed in situ on an outpatient basis. Treatment was carried out without the need for anesthesia or sedation in 94070 of the cases and without a ureteral catheter in 97%. This approach was effective in 88°70 of the patients who showed radiological evidence of fragmentation at the end of the procedure, and 81°70 of the patients were stone-free at the 3-month follow-up. A second ESWL treatment was necessary in 10°70 of the patients, of whom 12% required either endourological procedures or open surgery. ESWL should be the first therapeutic choice for all kinds of ureteral stones, since it has proved its effectiveness, avoiding hospitalization, anesthesia, and endourological maneuvers. The surgical treatment of urinary lithiasis has developed intensively over the last decade, with traditional open surgery being replaced by endourological procedures. Noninvasive treatments such as extracorporeal shockwave lithotripsy (ESWL) were initially employed to treat renal stones as well as calculi in the upper ureter that were associated with transureteral retrograde stone manipulation. The present report describes our experience with ESWL for the treatment in situ of ureteral stones in any location, without the need for anesthesia, ureteral manipulation or hospitalization. Between July 1988 and July 1989, 192 patients with ureteral stones were treated by ESWL (Lithostar, Siemens), 178 of whom were followed radiologica/ly and clinically. A single stone was present in 184 cases, and 2 stones were found in 8, for a total of 200 calculi. In all, 87 (43.5%) were located on the right side and 113 (56,5%), on the left side; 131 of the patients were men (68,2%) and 61 were women (31,8%). All treat-
Cureus
Introduction The optimal management of distal ureteral stones remains a matter of debate since current guidelines favor ureteroscopy over extracorporeal shock wave lithotripsy (ESWL). We aimed to evaluate the efficiency of ESWL for distal ureteral stones and to identify factors that affect treatment outcomes. Materials and methods The retrospective study included records of 115 patients with distal ureteral stones, 5 mm to 18 mm in size, undergoing 223 ESWL sessions as an outpatient procedure. Early fragmentation and three-month follow-up stone-free rate (SFR) was assessed through radiographic imaging. Treatment was successful if there were no residual fragments or they were ≤4 mm, three months after the last session. Results The mean ±standard deviation (range) stone size was 9.68 ±3.10 (5.00-18.0) mm. The mean body mass index (BMI) was 24.3 ±2.67 (18.4-29.8) kg/m² with a significant correlation between BMI and stone size (r 2 =0.324, p <0.001). Patients underwent ESWL an average of 1.7 ±1.36 times (1-5), while 68 patients (59.1%) became stone-free after one session. The overall SFR was 82.6%; for patients with stone sizes ≤10 mm and >10 mm, it was 99% and 9.4%, respectively. Cumulative SFR after the second session was 77%. In 20 (17%) patients the treatment was a failure. Complications occurred in 10.4%, while auxiliary procedures were needed in 8.7% of cases, both significantly affected by the stone size (p <0.001). The efficiency quotient (EQ) was 0.76. Treatment outcome was significantly different depending on stone size, BMI, number of sessions, complications, and auxiliary procedures (p <0.001, p =0.022, p <0.001, p <0.001, p <0.001, respectively). Univariate regression analysis identified stone size and BMI as significant predictors of treatment outcome (odds ratio (OR) 3.84, 95% confidence interval (CI): 2.31-8.97, p =0.001, and OR 1.25, 95% CI: 1.04-1.54, p =0.024, respectively). Conclusions Extracorporeal shock wave lithotripsy continues to be a safe and effective option for managing simple calculi in distal ureters with a diameter of ≤10 mm. The stone size and BMI remain significant predictors of treatment outcome.
Asian Journal of Pharmaceutical and Clinical Research Journal , 2021
Methods: A prospective study was conducted on patients with the upper ureteric stone of size 0.5-1.5 cm. A total of 50 patients were included in the study by means of systematic random sampling so as to get 25 patients in each category of ESWL and URS for the treatment of their upper ureteric calculi. Results: The age ranged from 15 years to 55 years. There were 36 males and 14 females in the study of 50 patients, 43 (86%) presented with pain, followed by 4 (8%) presented with hematuria. Twenty-eight (56%) of the patients had stone in the range of 0.5-1.0 cm, and 22 (44%) of the patients had stone in the range of 1.0-1.5 cm. Sixteen (32%) patients had stone within 2 cm of the pelvi-ureteric junction, and 13 (26%) had stone within 2 cm of the sacroiliac joint. Twenty-one (42%) patients had stone in between these two. Of the 50, 25 patients (50%) underwent shock wave lithotripsy, 25 patients (50%) underwent URS. In the ESWL group, 21 (84%) patients were stone-free after single sitting of ESWL. Four patients (16%) who required Re ESWL, after repeat ESWL two became stone-free however 2 (8%) patient of 1.0-1.5 cm category required secondary procedure, that is, URS and became stone free. To achieve stone-free 1.24 procedure was required per patients. Of the 25 patients in the ESWL group, 2 (8%) patient (one steinstrass case and one poor fragmentation case) required secondary procedure. They underwent URS. Both the patient belonged to 1.0-1.5 cm group. URS was done using semirigid ureteroscope using pneumatic Lithoclast. In our study, two patients of each 0.5-1.0 cm and 1.0-1.5 cm category did not become stone free. These four patients were subjected to ESWL and became stone free. Conclusion: The management of the ureteral stone should be decided on individual basis, based on stone size, location, symptoms, obstruction, and the availability of the instruments. For stones of 0.5-1.0 cm, ESWL is the treatment of choice for the upper ureteric stones, with very low Re-ESWL (1.12 sittings) without any requirement of ancilliary procedure. URS may be used for the upper ureteric stones but requirement of ancilliary procedure is high 11.11%. For stones between 1.1 cm and 1.5 cm, ESWL is the preferred modality of treatment for the upper ureteric stones.
Extracorporeal shock wave lithotripsy for distal ureteric stones: which is the ideal approach?
International Urology and Nephrology, 2020
Objective To compare the safety and efficacy of different approaches using ESWL for management of distal ureteric stone in an attempt to select the ideal one. Patients and methods This is a prospective randomized single-center study conducted on patients with lower third single radiopaque ureteric stone with size less than 15 mm. Patients were randomized into three groups, group A: Supine transgluteal, group B: Modified prone and group C: Prone position (80 patients each). The success of the procedure was assessed by NCCT and is defined as complete stone removal or had only clinically insignificant fragments (< 3 mm) for a maximum of three sessions. The success rate, rate of complications, pain intensity by visual pain scale and patients' satisfaction rate were compared among the three study groups. Results Data of 240 patients were analyzed (80 in each group). Overall, no significant difference has been observed among all groups regarding demographic data, stone and treatment characteristics. The overall success rates for treatment after the last session were 86.3%, 65% and 62.5% in the three study groups, respectively, with a statistically significant difference for group A. Regarding pain perception and complication rate, all groups were comparable. Patient satisfaction is significantly better in group A versus the other two groups. Conclusion Our study has confirmed better efficacy profile and patients' satisfaction rate of ESWL in the supine position (transgluteal approach) than other different known approaches for the treatment of distal ureteral stones.