Safety and efficacy of ureteroscopic pneumatic lithotripsy (original) (raw)
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Annals of the College of Medicine, Mosul
Objective: The purpose of this study is to compare ureteroscopy using pneumatic lithotripsy with open surgery (ureterolithotomy) in treating ureteric stones regarding the success rate, procedures time, need for post-operative analgesia, duration of hospital stay, and complications rate. Patients and methods: A prospective study of 90 patients suffering from ureteric stones, referred to the urology center at Al-Jumhori Teaching Hospital in Mosul city between 1 st of May 2010-31 st of March 2011. Fifty patients were treated by ureteroscopy and 40 patients by ureterolithotomy. Their age and sex distribution was comparable. Results of both treatment modalities were analyzed and compared. Results: The success rate for ureteroscopy was 90% and for ureterolithotomy was 97.5%. The procedure time was significantly shorter for ureteroscopy patients (21 minute versus 67 minute). Mean post-operative analgesia was much less for ureteroscopy (1.1 versus 9.5 analgesic injections). Ninety two percent of ureteroscopy patients were discharged at same day of operation with mean hospital stay of 1.12 days compared to 3.5 days for ureterolithotomy group. Complications were reported in 8% in ureteroscopy and 5% in ureterolithotomy group. Conclusion: The success rate of ureteroscopic procedures using pneumatic lithotripsy is comparable to that of ureterolithotomy, but with significantly shorter procedure time, less need for post-operative analgesia, shorter hospital stay, and with no significant increase in the complications rate. These results mean early return to social life and activities, and make ureteroscopy a preferable option for treating ureteric stone when facilities and surgical skills are available.
Journal of Endourology, 2012
INTRODUCTION AND OBJECTIVES: We report the results of a randomized controlled trial comparing three different lithotriptors using semirigid ureteroscopy (URS) for distal ureteral stones. METHODS: Between September 2009 and November 2010 69 patients undergoing ureteroscopy were randomized to three groups: LithoClast classic (Group 1), Holmium Laser (Group 2), and StoneBreakerTM (Group 3). A 7.5F semirigid ureteroscope was used in all procedures. The primary outcome was differences in fragmentation time. Secondary outcomes were stone-free rates, intraoperative complications, stone-up migration, hospital stay, analgesic requirement, and need for auxiliary procedures. Patients were followed up at 15 days, 30 days, and 3 months. The stone-free status was defined with noncontrast computed tomography performed at first control. Univariate and multivariate analysis were performed to determine clinical and surgical factors that have direct impact on the success of ureteroscopy. Chi-square test and Analysis of Covariance (ANCOVA) tests were used for statistical comparisons. RESULTS: There were no differences between sociodemographic variables. Average stone size was 7.17-2.04 mm in Group 1; 7.89-2.73 mm in Group 2; and 7.79-2.97 mm in Group 3 (p = 0.79). Fragmentation time were similar between lithotriptors; 27.12-4.07 minutes in Lithoclast group; 21.78-2.81 minutes in Laser group, and 27.14-4.71 minutes in StoneBreaker group (p = 0.74). Stone-free rates were 96 %-11.18 % (group 1), 96.9 %-8 % (group 2), and 96.9 %-8.4 % (group 3) (p = 0.1). No difference was observed in stone-up migration, postoperative Double-J stent placement, or auxiliary procedures. Stone size and the placement of a second working wire were associated with shorter fragmentation time (p < 0.01). CONCLUSIONS: The three lithotripsy devices evaluated behaved similarly in terms of the ability to fragment stones, and were equally effective for distal ureteral stones. Adequate fragmentation and fragment removal are mainly dependant on stone size and surgical technique (use of auxiliary wire).
Semirigid ureteroscopy with pneumatic lithotripsy for ureteral stone
Journal of Nepal Health Research Council, 2011
Ureteral stones present with acute loin to groin pain. The objective of this study is to find out the outcome and safety of semi-rigid ureterscopy with pneumatic lithotripsy for treatment of ureteral stones of >30 mm(2) and to assess the impact of size and location on stone free (SF) rate. Total 110 patients with isolated ureteral stone size>30 mm(2) were included in this study and treated with pneumatic lithotripsy using 8/9.8 Fr. Semi-rigid ureteroscope (Stiema Germany). Stones were fragmented into 2-3 mm particles and removed. Outcome parameters assessed at 3 months follow up were stone free rate(SF),Efficiency Quotient (EQ), and impact of stone size and site on SF/EQ was also analyzed. Similarly, patient demographics, procedures, patient related parameters and complications were also noted. The overall SF rate at 3 months follow up was 69.33% and efficient Quotient (EQ) 52.52%. The SF/EQ for upper, middle and lower third of ureteral stone was 55/37.67, 61/43.57, 92/84.40 r...
Journal of Endourology, 2009
Objectives: To study the outcome and safety of semirigid ureteroscopy (URS) using pneumatic lithotripsy for treatment of ureteral stones of surface area >30 mm 2 and to assess the impact of size and location on stone-free (SF) rate. Patients and Methods: In this study, 265 patients with >30 mm 2 isolated ureteral stones treated by semirigid URS were included. URS was performed using an 8F, 7F, or 6.4F semirigid ureteroscopes with pneumatic lithotripsy (Swiss LithoclastÔ). Stones were fragmented to *2-3 mm particles, and removed. The outcome parameters assessed at 3-month follow-up were SF rate and efficiency quotient (EQ); impact of stone size and site on SF=EQ was also analyzed. The patient demographics, stone, procedure, and patient-related parameters and complications were noted. Results: At 3-month follow-up overall SF was 74% and EQ 59.2%. SF for 30-100 mm 2 and >100 mm 2 was 79.2% and 68.5%, respectively ( p < 0.003). The SF=EQ for upper, middle, and lower ureteral stones were 59=40.7, 53=37.5, and 92=84.5, respectively ( p < 0.001). There was no major complication; the minor complication rate was 12.5%. Conclusions: Semirigid URS using pneumatic lithotripsy for treatment of stones >30 mm 2 is a safe and highly efficacious procedure particularly in the distal ureter. There is a significant difference in the SF and EQ between upper=middle ureteral stone and lower ureteral stone. Stone size has a direct relation with the SF and EQ. Upper ureteral stones have a longer time to SF compared to middle and lower ureteral stones ( p < 0.001). Abbreviations Used CT ¼ computed tomography EQ ¼ efficiency quotient IVU ¼ intravenous urogram KUB ¼ kidney, ureter, and bladder radiograph SF ¼ stone free SWL ¼ shock wave lithotripsy URS ¼ ureteroscopy US ¼ ultrasound v ¼ versus 622 ATHER ET AL.
Ureteroscopic pneumatic lithotripsy of impacted ureteral calculi
International Braz J Urol, 2006
Introduction: This work evaluates the results of ureteroscopic treatment of impacted ureteral stones with a pneumatic lithotripter. Materials and Methods: From March 1997 to May 2002, 42 patients with impacted ureteral stones were treated by retrograde ureteroscopic pneumatic lithotripsy. Twenty-eight patients were female and 14 were male. The stone size ranged from 5 to 20 mm. The ureteral sites of the stones were distal in 21, middle in 12 and proximal in 9. Results: Considering stones with distal location in the ureter, 1 patient had ureteral perforation and developed a stricture in the follow-up (4.7%). As for stones in the middle ureter, 2 perforations and 1 stricture were observed (8.3%) and regarding stones located in the proximal ureter, 5 perforations and 4 strictures occurred (44%). In the mid ureter, 1 ureteral avulsion was verified. In 34 patients without ureteral perforation, only 1 developed a stricture (2.9%). Of 8 patients who had perforation, 6 developed strictures. The overall incidence of stricture following treatment of impacted ureteral calculi was 14.2%. Conclusions: Ureteroscopy for impacted ureteral calculi is associated with a higher incidence of ureteral perforation and stricture. Ureteroscopy of proximal ureteral calculi is associated with a high risk of perforation, when compared to mid or distal ureteral calculi. Ureteral perforation at the site of the stone seems to be the primary risk factor for stricture formation in these cases.
International Surgery Journal
Background: Ureteric calculi are one of the most common cause of abdominal pain in the emergency room. There are several options for the management of ureteric stones. Ureterorenoscopy and lithotripsy is the commonly used modality because it is less morbid and invasive, but the drawback is proximal stone migration which leads to persisting symptoms and increased costs. The aim of this study is to use an anti-retropulsion device to reduce the rate of proximal stone migration.Methods: This description study was conducted in Sree Gokulam Medical college from December 2014 to December 2015, on 75 consecutive patients who had ureteric stones, of ages 20-60 who were willing to give consent. All patients underwent ureteroscopy and lithotripsy and in those patients from who anti-retropulsion device could not be manipulated proximal to the stone lithotripsy alone was done. Both groups were compared for procedure time, post-operative symptoms and stone free rates.Results: The average time tak...
The professional medical journal, 2019
Materials and Methods: 32 patients from medical record who underwent for stone clearance with ureteroscopy followed by lithoclast. The patients with larger upper ureteral stones were enrolled in the study though patients with stone size<1cm and co-morbidities were not included in the study. The characteristic of patients and stone, treatment modality & outcome i.e. efficacy in terms of "successful stone clearance" were determined. Results: The average age of 32 patients was 34.28±10.11 years. 18 (56.3%) of the patients were females whereas 14 (43.7%) were males. Ureteric stones were present on both right and left sides in 17 (54%) and 15(46%) patients. Bilateral ureteric stone was present in 2 (6.25%) patients. The efficacy was reported as 96% for the stone size of 1-1.5cm and 92% for the stone size of 1.6-3cm. Conclusions: We concluded that Ureterorenoscope followed by Lithoclast is the useful and safest procedure for stone clearance.
Urological Research, 2005
Ureteroscopes and different lithotripsy methods have greatly improved the urologist's ability to treat ureteral stones, regardless of their location in the ureter. We retrospectively reviewed our experience with ureteroscopic pneumatic lithotriptor in 287 patients with ureteral calculi. Ureteroscopic stone treatment was performed between October 1999 and May 2004. Of 221 patients with distal ureteral calculi, 209 (group 1), and 58 of 66 patients with upper ureteral calculi (group 2) were treated successfully by ureteroscopy alone. In group 1, seven migrated stones (to the upper urinary tract) were successfully treated by ESWL later. There were fivetreatment failures due to ureteral perforation which consequently required open ureterolithotomy. In group 2, there were five patients with migrated stones; two of them were sent to a percutaneous nephrolithotomy center because of previously unsuccessful ESWL attempts. Three of these with migrated stones were treated by ESWL later. In three patients, we switched to open ureterolithotomy because of ureteral rupture that required surgical repair. Ureteroscopic pneumatic lithotripsy is a safe and effective treatment modality for ureteral calculi.
A STUDY TO DETERMINE THE SAFETY AND EFFICACY OF PATIENTS UNDERGOING URETEROSCOPIC LITHOTRIPSY
Dr Urooj Asad, Dr Sana Asghar, Dr Hajra Arshad Butt
Objective: To determine the safety and efficacy of the patients undergoing ureteroscopic lithotripsy – a surgical procedure. Methodology: The study was carried out in Alshifa Hospital Mirpur AJK and the duration of this study was from December 2019 to December 2020. The patients under discussion were from both genders. The subjects’ routine medical exam, laboratory tests, blood pictures, ultra-sounds and x-rays were collected and patients with ureters stone of 1.5cm or less were segregated for the study. The Semi-rigid Ureteroscopic (6.0) with Swiss Lithoclast lithotripter was used. Results: A sample of 320 patients was selected according to inclusion criteria. Female and male ratio was 1:1.6 and average age value for the sample was calculated as 30.5 year. The stone diameters were averagely 1.2 cm. In 95% cases (n=304), the procedures yielded outstanding results. The stones were broken and crushed successfully. In remaining 16 cases (5%), the procedure was postponed. Among them, 3% cases were due to the reason that ureteroscope could not locate the exact position of the stones whereas in 2% cases JJ stent were used where the stones floated up I the kidney (p< 0.05). The operative and post-operative complications such as simple mucosal injury, minor bleeding urinary tract infection persisting haematuria were noted in the subjects. The surgery time was less than one hour in all cases and ranged from 22 to 55 minutes. Except the patients with post-operative complications, rests were discharged from the hospitals within 24 hours of operation. Post operation visits till 3rd week demonstrated the stone residual pieces only in 6 patients. Conclusion: In spite of the fact that our study has yielded encouraging results for ureteroscope lithotripsy with merely a day at hospital but is subordinate on numerous possibly changeable and process-related components. KEY WORDS: Mucosal Injury, Ureteroscopy, Kidney, Urine, Therapies, Lithoclast
Research and Reports in Urology
In this study we aimed to assess and compare the rate of sem-irigid ureterorenoscope in the treatment of upper and lower ureter stones through pneumatic lithotripsy (PL). Materials and Methods: Ninety-two patients with a mean age±SD of 45±15years who had had a surgical procedure performed by the same experienced surgeon between January 2013 and July 2015 were included in the study. The mean±SD stone size was 8.8 ±2.6 mm. Forty-two of the patients (45.7%) had upper ureter stones and 50 (54.3%) had lower ureter stones in order to increase the success rate and avoid stone migration. The medical files of the patients were reviewed regarding age, sex, stone size, stone location, success rate, complications, and presence of hydronephrosis. Success was operationally defined as the complete fragmentation of stone to very small parts that could pass or complete extraction of the stone. Results: Eighty-four of the patients were stone free (91%). The success rates for patients with upper or lower ureteric stones were 93% and 90%, respectively (P=0.63). There were no complications during the operation. However, 4 patients (4.4%) had postoperative complications in terms of urinary tract infection or urosepsis. Those were accurately managed by the suitable medical treatment. Conclusion: Semi-rigid ureterorenoscopy by using PL was a safe and practical treatment option for managing the upper and lower ureter stones. Performing the tips and tricks of ureterorenoscopy by an experienced surgeon seems to enhance the success rate, especially in upper ureter stones.