Extracorporeal Shock Wave Lithotripsy of Upper Ureteral Stones: In Situ v Push and Smash Treatment*

Abstract

In a retrospective study, the data of 102 patients were evaluated for effectiveness of treatment of upper ureteral calculi by extracorporeal shock wave lithotripsy (SWL) alone (in situ) or after repositioning of (push and smash) (53 cases). Whereas no significant differences were seen concerning the duration of stone impaction and obstruction, significant differences were found concerning the number of treatments per patient (1.5 1.2) and the number of shock waves (1500 1240) necessary to destroy the stones. The calculi treated in situ necessitated a considerably higher number of auxiliary measures (ureteral catheterization, double-J stent insertion). The stone-free rates after 6 months were comparable in the two groups. Ureteral catheter mobilization of obstructive upper ureteral calculi prior to SWL provides for short and uneventful passage of fragments.

Laparoscopic ureterolithotomy: Our experience with 74 cases

“…So, laparoscopic ureterolithotomy is a feasible alternative for treating these difficult stones. 10,11 As is evident from many clinical series, the distinct advantage of laparoscopic ureterolithotomy is the high probability of removing an impacted stone in one session without the need for additional procedures. This fact is the most important in Upper Egypt (Assiut), which forms part of the 'stone belt' with high rates of stone formation and recurrence, so most of the patients prefer to remove the stone in one session.…”

Extracorporeal Shock Wave Lithotripsy for Obstructed Proximal Ureteral Stones

“…Previous investigations revealed a stone-free rate as high as 95-99% was achieved if the stones could be successfully manipulated back into the renal pelvis [10][11][12], However, the 'push-and-bang' treatment is not always feasible when dealing with impacted ureteral stones. As experience was gained, retrograde repositioning of stone was accom plished in 37-85% of cases and carried a complication rate of at least 5% [12][13][14], In situ ESWL has been attempted with great success to treat ureteral stones not amenable to backward manipulation. Therefore, by some, in situ treatment without any manipulation has been advocated as the method of choice for proximal ureteral stone [15], while still others recommended bypassing the stone with a double-J stent or placing a ureteral catheter beneath the stone with continuous irrigation during the shock wave therapy because they felt that creation of a fluid-stone interface would potentiate the pulverization effect [16].…”

Laparoscopic ureterolithotomy: minimally invasive second line treatment

“…Transperitoneal approach and retroperitoneal approach were both used according to personal preference and both approaches demonstrated to be feasible and effective in performing ureterolithotomy [5][6][7][8][9][10][11][12][13].…”