Extracorporeal shockwave lithotripsy (SWL) and ureteroscopic manipulation became the standard treatments for ureteral stones in recent years. There still exists significant debate as to the most appropriate treatment modality for ureteral stones. During a period of 2 years, from January 1994 to December 1995, 651 patients with ureteral stones were treated, and 589 patients were retrospectively reviewed, excluding 62 patients with incomplete follow-up. Four hundred forty-two patients were treated with SWL using the MPL 9000 with ultrasonic guidance and 115 patients with ureteroscopic manipulations using 7.9F to 11.5F rigid and semirigid ureteroscopes. In SWL treatments, the overall stone-free rate was 74.7% with one session. The stone-free rate was significantly affected by the size of stones, being 83.6% when the stone was <1.0 cm and 42.1% when the stone was >1.0 cm. The stone-free rate after a second SWL session was 84.4% and was 90.3% after a third session. The stone-free rates according to the site of the stone were 72.4 (proximal), 70.0 (mid), and 80.2% (distal) after a single session. In ureteroscopic manipulation, an overall stone-free rate of 87.8% was obtained regardless of the size of the stones. The success rates according to the location of stones were 75.0 (proximal), 94.6 (mid), and 86.4% (distal). Open ureterolithotomy was performed in 32 patients, with a 100% success rate. In our study, the size of the stones was the most important factor influencing the success rate of SWL treatment. We consider ureteroscopic manipulation as the first-line treatment modality when the stone is >1.0 cm, especially if it is in the distal ureter. Proper selection of patients for in situ SWL or ureteroscopy would improve the results of initial treatment.
PurposeTo compare the outcomes of open pyeloplasty (OP), laparoscopy-assisted extracorporeal (LEXP), and robotic-assisted laparoscopic pyeloplasty (RALP) for ureteropelvic junction obstruction in pediatric patients.MethodsWe retrospectively reviewed the age-matched cohort of 30 children who underwent OP, 30 who underwent LEXP, and 10 who underwent RALP at a single institution, from 1996 to 2014. Pre- and post-operative variables including success rate were compared among surgical groups.ResultsThe mean age of the patients was 120.2 months, the Society for Fetal Urology grade was 3.6, the anteroposterior diameter was 3.1 cm, and the renal relative function was 44.0%. The distribution of laterality, mean body mass index, and preoperative anteroposterior pelvic diameter on ultrasound did not differ among groups. The mean length of hospital stay was significantly shorter in the RALP group (3.2 days) than in the OP (6.6 days) and LEXP (5.8 days) groups (p<0.001). The duration of analgesics use was shorter in the RALP group (1.1 days) than in the other groups (p<0.001). During the mean follow-up period of 49.0, 20.1, and 16.6 months, the success rate was 96.7%, 89.7%, and 100% in the OP, LEXP, and RALP groups, respectively, although this difference was not statistically different (p = 0.499). In multivariate regression analysis, the presence of crossing vessels was the only factor that decreased the success rate (hazard ratio: 46.09, 95% confidence interval: 2.41–879.6, p = 0.011).ConclusionsPatients who undergo RALP have a reduced hospital stay and lower use of pain medication; however, there is no difference in the success rates for OP, LP, and RALP surgeries. The presence of crossing vessels is a negative prognostic indicator for surgical outcome regardless of the surgical method.
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