ABSTRACT
Background: Urinary stones are the third most common affliction of urinary tract, exceeded only by urinary tract infections and pathological conditions of prostate (BPH and Prostate cancer). Extracorporeal Shock Wave Lithotripsy (ESWL) and Uretero-renoscopic Lithotripsy (URSL) are among various treatment options available. Aims and Objectives:To compare ESWLand URSLprocedural and post procedural characteristics including outcome. Methods: A Prospective study was conducted in the department of Urology, SKIMS, on 100 patients with proximal Ureteric stone, from September 2015 to July 2017.By random selection, fifty patients were subjected to ESWL and another fifty to URSL. Various parameters were recorded on preformed proforma designed for the comparative study. Results: In our study, Parameters like Age and Gender distribution, symptoms at presentation and duration of symptoms, number of stones, laterality of stones (right/left) and grade of Hydronephrosis or Hydroureteronephrosis were uniformly distributed in the two groups (URSL VS ESWL). Spinal anaesthesia (SA) or General Anaesthesia(GA) was required in URSL group only, while as local anaesthesia and sedation was required in some patients in ESWLgroup. 72% and 88% patients achieved stone clearance in ESWLand URSLgroup respectively, (p=0.046). DJ stent was used in 20% of URSL patients and none in ESWL group. Procedure time was relatively less for URSL (p=0.001). Although statistically insignificant, Post procedure hematuria and urosepsis were higher in URSL group, where as pain/colic and fever was slightly higher in ESWL group. Steinstrasse was significantly higher in ESWL group (p=0.008). Hospital stay was significantly higher in URSL group (p<0.001). Cost involvement was higher in ESWLgroup (p=0.016). Conclusion: Although ESWL is regarded as the preferred choice of treatment for upper Ureteric stone, URSL is a safe alternative, with an advantage of obtaining an earlier or immediate stone free status in patients with stone size >10mm. In patients with smaller stones (<10mm), ESWL may be considered a reasonable alternative to URSL.
ABSTRACT
To evaluate the predisposing factors and characteristics of the steinstrasse after ESWL and to suggest the proper management of it, we analyzed 1,144 urolithiasis patients who were managed by ESWL with the second generation lithotripter, Siemens Lithostar, at Seoul National University Hospital from March 1989 to October 1995. Steinstrasse developed in 72 patients with the incidence of 6.3% after ESWL. As the risk factor for developing steinstrasse after ESWL, stone size and volume significantly influenced the development of steinstrasse (p<0.01, by student t-test), and multiple stones induced steinstrasse more frequently than single stones (p<0.05, by chi-square test). Stones located at renal pelvis induced more steinstrasse after ESWL than calyceal stones or ureter stones t<0.05, by chi-square test). Clinically, 61.1% of the patients who developed steinstrasse didn't have any symptoms or upper tract changes. Nineteen steinstrasse (26.4%) were resolved spontaneously without any intervention, with the median duration of 12 days after detection of the steinstrasse. In 51 steinstrasse which was not resolved spontaneously or with severe symptoms, ESWL was performed resulting in successful resolution in 94.1% of the patients. These results suggest that expectancy could be the first line strategy of the management of steinstrasse, and repeated ESWL could be recommended for patients refractory to expectancy and patients with severe symptoms.
Subject(s)
Humans , Causality , Incidence , Kidney Pelvis , Risk Factors , Seoul , Ureter , UrolithiasisABSTRACT
We analyzed the incidence and treatment of steinstrasse in 470 patients(renal units-521 cases) who underwent ESWL treatment for renal stones using a Piezolith 2300 piezoelectric lithotriptor between April 1990 and July 1993. Of 521 renal stones, a total of 44 cases(8.5%) developed steinstrasse. The most common location for steinstrasse was in the lower ureter(72.7%), followed by upper ureter(22.7%) and mid-ureter(4.6%). In these 44 cases, stone fragments passed spontaneously in 23 cases(52.3%) and mean duration to spontaneous passage was 15.7 days(range 1-43 days). Repeated ESWL was performed on steinstrasse in 20 cases. Successful treatment (no residual stone fragments in the ureter) was achieved in 18 cases(90%) and the mean number of sessions was 1.3. There was no significant complication after repeated ESWL. Only 2 patients who failed ESWL treatment required open ureterolithotomy. The remained 1 patient with mid-ureteral steinstrasse underwent ureteroscopic management. With this result, repeated ESWL seems to be effective and safe in the treatment of steinstrasse which is not expected to pass spontaneously.
Subject(s)
Humans , IncidenceABSTRACT
Early in the experience of ESWL, steinstrasse was recognized as potential complication and suggestions for management were proposed. including retrograde ureteral manipulation. placement of ureteral stent or percutaneous nephrostomy, etc. Recently ESWL has been challenged due to less invasive and safer procedure. We experienced 18 cases (2.1%) of steinstrasse in 850 patients with ESWL (EDAP LT-01) from February, 1989 to February, l99l and treated with ESWL. The results were obtained as follows. 1. The primary stones in 18 cases of steinstrasse were renal stones in l7 cases (complete staghorn calculi; 4 cases. partial staghorn calculi; 5 cases) and upper ureteral stone in 1 case: 2. The sites of steinstrasse were lower ureter in 13 cases and upper ureter in 5 cases. The lengths of steinstrasse were 1.4~8.3cm (mean: 3.19cm). The site and length of steinstrasse were not related with clinical symptoms. 3. Of l8 cases. 13 cases were type 1. 3 cases type II and 2 cases type III. Type of steinstrasse was not related with clinical symptoms. 4. Six cases were asymptomatic and 3 cases of symptomatic steinstrasse required hospitalization. 5. Fifteen cases were treated with ESWL only and 2 cases of solitary kidney were treated with ESWL, after percutaneous nephrostomy. Early experienced 1 case was treated with ureteroscopic removal of stone. 6. Of 17 cases treated with ESWL, stone fragments expelled out within 1 month in 13 cases, 2 months in 3 cases and 4 months in 1 case of solitary kidney. All symptoms of steinstrasse were relieved within 3 days after ESWL.