Management of Ureteral Calculi

Gerber, Glenn S.; Acharya, Sujeet S.

doi:10.1089/end.2009.0683

Cited by 14 publications

(5 citation statements)

References 6 publications

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“…This is consistent with published results reported by other centers performing holmium laser lithotripsy [6, 7, 8, 14–18]. …”

Section: Discussionsupporting

confidence: 93%

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ENDOUROLOGY Endoscopic holmium laser treatment for ureterolithiasis

Purpurowicz¹,

Sosnowski²

2012

cejurol1/2012

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IntroductionThe rapid development and invention of ever more technologically advanced ureterorenoscopes as well as other instruments used in fragmenting ureteral stones have made the traditional surgical treatment of ureterolithiasis very rare.Material and methodsWe investigated 727 patients treated for ureterolithiasis. 769 ureteroscopic lithotripsies (URSL) with the holmium laser were performed. We evaluated the relation of the stone size, the section of the ureter involved, length of time of the stone within the ureter and the condition of the urinary tract to the results of the ureterolithiasis treatment.ResultsA good result of breaking up the stone and passing its fragments out of the ureter within 3 months following the first URSL was observed in 642 (90.9%) out of 706 patients. The remaining 64 (9.1%) patients required additional procedures: ESWL was performed on 44 patients; URSL was repeated for 20 patients. The most serious early post-URSL complications involved: urinary tract infection with symptoms of urosepsis in 10 patients, leading to death in 1 case, ureteral perforation in 3 patients, including 1 case presenting a periureteral leak that necessitated a surgical intervention.ConclusionsURSL with the holmium laser is an effective and safe method for treating ureterolithiasis.

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“…This is consistent with published results reported by other centers performing holmium laser lithotripsy [6, 7, 8, 14–18]. …”

Section: Discussionsupporting

confidence: 93%

“…The precise placement of the fiber tip in direct contact with the stone prevents damage to the ureteral wall. Recently, the employment of holmium laser lithotripsy has become more and more common [6, 7, 8]. …”

Section: Introductionmentioning

confidence: 99%

ENDOUROLOGY Endoscopic holmium laser treatment for ureterolithiasis

Purpurowicz¹,

Sosnowski²

2012

cejurol1/2012

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“…Recently there has been an increase in the trend for using URS for stones in every day practice. In a survey, which was conducted using the electronic mail lists of the AUA and the Endourological Society, 75% and 30–40% of the urologists will use URS for mid‐ and upper ureteric stones, respectively [49]. This certainly constitutes an improvement when compared with the 50% and 15% figures in an older report [50].…”

Section: Discussionmentioning

confidence: 99%

Training in ureteroscopy: a critical appraisal of the literature

et al. 2011

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What’s known on the subject? and What does the study add? Ureteroscopy outcome depends on the availability of the technological equipment and the surgeon experience. This study tries to define the learning curve of ureteroscopy, to underline the current quality of training and to propose the minimum requirements for a curriculum in ureteroscopy. The aim of the present review was to study factors influencing training and the maintenance of skills in performing ureteroscopy (URS). We searched on the following keywords in the Medline, Embase and Cochrane databases: renal or ureteric stone; ureteroscopy; endourology; educational; training; learning curve; expertise; skill; residency; practice; simulator; and robotics. We have defined, when possible, levels and grades of evidence, based on 2009 recommendations of the Oxford Centre for Evidence‐Based Medicine. We found that technological advancement and surgeon experience is a predictive factor for success or complications of URS. Experience may be related to special endourology training, time passed after basic training and the number of procedures performed. Studies suggest that a resident must perform a certain amount of cases to gain proficiency with URS, but there is still a need for well designed studies for the learning curve of URS to be accurately defined. Training models may be useful for training in URS and stone disintegration. Stone centres that provide all the endoscopic treatment options seem to provide the best conditions to ensure a sufficient volume of patients required. Defining minimum requirements for training in URS and for maintaining certification is a major challenge, as is defining the learning curve in URS. Careful curriculum design in high‐volume stone centres may be the key to optimizing URS training.

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“…A similar preference was seen in the treatment of mid-ureteral stones, though the margin was slightly narrower. In the treatment of proximal ureteral stones, the majority favored SWL by nearly 3:1 [110].…”

Section: Laser Lithotripsymentioning

confidence: 99%

Urological Aspects of Management

Miller

Stoller

2011

Clinic Rev Bone Miner Metab

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Renal colic describes the acute, severe, and paroxysmal pain caused by the obstruction, distension, and resultant increase in intraluminal pressure of the urinary tract. The treatment of renal colic is aimed at relief of symptoms, facilitating urinary drainage to preserve renal function and treat infection and ultimately removal or passage of the obstructing stone. The medical management of renal colic is directed at mitigating, through pharmacologic intervention, one or more of the complex processes contributing to the clinical sequelae of obstruction including pain, nausea, vomiting, and irritative voiding symptoms. Numerous medications and combinations of medications have been employed with varying degrees of clinical success. Urgent interventions are typically directed at bypassing ureteral obstruction in order to palliate the patient until such time as definitive treatment may be accomplished or facilitate drainage to further the treatment of urinary tract infection. Timing and mode of urgent intervention are dependent on clinical factors, clinician expertise, and preference and the availability of specialized equipment. Definitive management of ureteral stones is typically performed in an elective fashion and seeks to balance the risks of intervention with the clinical benefits of the various treatment modalities. Treatment approaches vary according to clinical indications, patient preference, clinician expertise, and the availability of facilities and equipment. This section covers current supporting evidence and rationale, indications and techniques for the medical management, urgent intervention, and definitive management of acute renal colic caused by ureteral stones.

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Management of Ureteral Calculi

Cited by 14 publications

References 6 publications

ENDOUROLOGY Endoscopic holmium laser treatment for ureterolithiasis

ENDOUROLOGY Endoscopic holmium laser treatment for ureterolithiasis

Training in ureteroscopy: a critical appraisal of the literature

Urological Aspects of Management

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