Endoscopic management of ureteric stones: our initial experience

The aim of this study is to present our initial experience with intracorporeal pneumatic ureterolithotripsy highlighting the pattern of patients' clinical presentation, techniques, and limitation of the procedure.Materials and Methods:This is a retrospective study of cases of ureteric stones managed over a period of 18 months in a private hospital. Data obtained include patients' sociodemography, clinical presentation, stone burden, procedural technique, complication, and need for a secondary procedure. Data were analyzed using the Statistical Package for the Social Sciences version 21.Results:The total number of patients managed was 20 with an age range of 28­75 years and a mean of 48.2 ± 12.4 years. Majority of them, i.e., 11 (55%) were middle aged. Female gender was more predominant, 11 (55%). Flank pain was the most common mode of presentation. Right-sided stone occurred in 9 (45%), left sided in 7 (35%), and bilateral in 4 (20%). Stone location was in the upper ureter in 4 (16.7%), mid-ureter in 7 (29.2%), and lower ureter in 13 (54.2%). The stone size ranged from 6 to 18 mm with a mean of 9.7 ± 2.5 mm. Four patients (20%) required initial bilateral ureteric stenting before definitive procedure to allow for recovery from sepsis and/or nephropathy. All patients had double-J stenting and were discharged 2 days after the procedure. The procedure was successful in 19 (95%) with 100% stone clearance rate and complete resolution of symptom without any complication. One patient (5%) had a very hard upper ureteric stone which retropulsed into the renal pelvis requiring open nephrolithotomy.Conclusion:Endoscopic treatment of ureteric stone with intracorporeal pneumatic lithotripsy is a safe and effective treatment modality. It is, however, limited in the management of hard upper ureteric stone, especially those that are close to the pelviureteric junction due to the risk of retropulsion of the stone into the kidney

Extracorporeal shock wave lithotripsy versus lasertripsy for the treatment of upper ureteric calculi

Objectives: To compare the efficacy, cost effectiveness and safety of both ESWL and Holmium:YAG laser lithotripsy for the management of upper ureteric stones.Patients and Methods: One hundred and eight patients of various age groups and of both sexes who had primary or recurrent unilateral or bilateral upper ureteric stones underwent 108 primary procedures and 19 ancillary procedures (total: 127) including in-situ ESWL (60 patients) using the Dornier MPL 9000 machine and ureteroscopy combined with Holmium:YAG laser lithotripsy (46 patients). Results: The overall stone-free rate was (93.75%) for cases subjected to uretero-scopy in combination with laser lithotripsy and (91.7%) for cases subjected to ESWL. For stones < 1 cm, the success rate was 100% in the laser and 95.65% in the ESWL group. For stones > 1 cm, the success rate was 90% in the laser and 78.6% in the ESWL group. For impacted stones, the success rate was 92.85% in the laser and 72.7% in the ESWL group. The EQ for the laser and ESWL groups was 0.86 and 0.73, respectively. The complication rate was 12.53% in the laser and 11.7% in the ESWL group. The average cost (in Egyptian pounds) was 1618.1 £E for Holmium: YAG laser treatment and 1069.1 £E for ESWL treatment. Conclusion: Apart from impacted stones and stones larger than 1 cm, ESWL is the first line of choice as a treatment modality for upper ureteric stones. However both ESWL and URS combined with holmium: YAG laser lithotripsy may be complementary to each other in treating upper ureteric stones

Assiut experience in the application of holmium laser in treatment of ureteral calculi in adults

Objective This study was carried out to evaluate the safety and efficacy of holmium:YAG laser in the treatment of ureteral calculi in adults. Patients and Methods Between April 1999 and November 2000; one hundred and seven patients presented to the urology department of Assiut university with symptomatic ureteral stone disease in different locations. The patients were divided into three groups according to the stone location which was determined radiologically. Group I included 38 patients with stones located in the upper third of the ureter; Group II included 19 patients with stones located in the middle third of the ureter and Group III included 50 patients with stones located in the lower third of the ureter. Lithotripsy was done in all patients using the Holmium:YAG laser machine. The stone-free status was checked three months after the procedure. Patients with residual stones were scheduled for another session. Results In Group I; 38 patients with 38 stones underwent 39 procedures for intracorporeal lithotripsy. Eight patients presented with obstructive anuria and elevated blood urea and serum creatinine. Complete stone fragmentation was achieved in 37 cases; while in one case the stone migrated to the kidney and was treated by ESWL. In Group II; 19 patients underwent 20 procedures. Re-treatment after three weeks was necessary in one case due to ureteral wall injury and minimal extravasation. Four patients presented with obstructive anuria; while in 6 patients the stones were impacted. Complete fragmentation could be achieved in all cases. In Group III; 50 patients underwent 51 procedures. A re-treatment session was required in one patient after three months due to a residual stone (5 mm) detected during follow up. In eleven cases the stones were impacted; and one patient had bilateral lower ureteral stones treated in the same session. Out of 50 patients with 55 stones; 54 stones (98.1) were completely fragmented and cleared in a single session. Conclusion Holmium:YAG laser lithotripsy is a safe and effective modality for the treatment of ureteral stones.Key Words Holmium:YAG laser; ureter; lithotripsy

La chirurgie endoscopique bilaterale et simultanee du haut appareil dans le traitement des lithiases renales et ureterales

Objective: To assess the outcome of simultaneous bilateral endoscopic surgery in the management of renal and ureteral lithiasis. Patients and Methods: Five patients were reviewed retrospectively. Two patients underwent bilateral simultaneous ureteroscopy for ureteral calculi; on two others bilateral simultaneous PCNL was performed in treatment of renal lithiasis. In one patient bilateral simultaneous ureteroscopic extraction of ureteral calculi was done prior to bilateral PCNL for renal lithiasis. Ureteral stenting was performed in all patients. In those patients who underwent PCNL a nephrostomy was done. Results: In all patients who had undergone PCNL the outcome was considered satisfactory. One of them had residual stones of less than 3 mm in both kidneys; which required only surveillance. Another patient had residual calculi in both kidneys with a diameter of 6 and 7 mm respectively. In this patient a complementary ESWL was necessary. The last patient was stonefree after the procedure. The results of simultaneous bilateral ureteroscopy assessed one month after the procedure with a plain abdominal film and renal ultrasonography were excellent since all patients were free of stones. An important haemorrhage complicating a PCNL was treated by embolization. Conclusion: Simultaneous bilateral endoscopic surgery of the upper urinary tract is a good alternative after failure of ESWL for renal and ureteral lithiasis. The risks and complications of the procedure are comparable to those of endoscopic unilateral surgery of the upper tract

Retroperitoneal laparoscopic treatment of large ureteral calculi not amenable for less invasive procedures

Objectives To evaluate retroperitoneal laparoscopic ureterolithotomy as an alternative line of treatment for ureteral stones not amenable for other less invasive procedures. Patients and Methods Retroperitoneal laparoscopic ureterolithotomy was tried in 34 patients with impacted upper ureteral stones (27 patients) and middle ureteral stones (7 patients). Mean stone size was 16 mm. Twenty-six patients were males and 8 were females with a mean age of 36 years (range 18 - 54 years). Results The procedure was successful in 29 cases (85.3); while 5 cases (14.7) required open surgery. The mean operative time was 55 minutes (range 25 - 90 minutes). No major intraoperative complications were encountered. No blood transfusion was required. Mean hospital stay was 6 days. Postoperative complications in the form of prolonged urinary leakage and high-grade fever occurred in 2 patients (5.9) and 1 patient (2.9); respectively. Conclusion Retroperitoneal laparoscopic ureterolithotomy is a good minimally invasive alternative line of treatment for ureteral stones in cases not amenable for ESWL or endoscopy. However; it takes a long learning curve. Moreover; a careful case selection and good working instruments are necessary for success