ABSTRACT
The purpose of this study is to compare the outcomes of transperitoneal laparoscopic ureterolithotomy (TPLU), retrograde flexible ureteroscopy (R-fURS), and mini-percutaneous antegrade flexible ureteroscopy (A-fURS) for treating large (≥ 15 mm) impacted proximal ureteral stones. A total of 105 adult patients were randomized into 3 equal groups: group A (35) patients underwent TPLU, group B (35) patients underwent R-fURS, and group C (35) patients underwent A-fURS. The initial stone-free rate was 100%, 68.6%, and 80% in groups A, B, and C, respectively. The mean operative time (OT) was (85.0 ± 7.57 min) in group A, (61.0 ± 8.21 min) in group B, and (89.57 ± 15.12 min) in group C. The three groups were comparable concerning the overall complications. R-fURS is a less invasive modality for treating such stones; however, it is associated with a lower SFR and a higher rate of auxiliary procedures. Both TPLU and miniperc A-fURS are effective and valuable alternatives for treating large impacted proximal ureteric stones.
Subject(s)
Laparoscopy , Lithotripsy , Ureteral Calculi , Ureteroscopy , Humans , Ureteroscopy/methods , Ureteroscopy/instrumentation , Ureteral Calculi/surgery , Ureteral Calculi/therapy , Female , Male , Adult , Laparoscopy/methods , Prospective Studies , Middle Aged , Lithotripsy/methods , Treatment Outcome , Operative Time , UreteroscopesABSTRACT
OBJECTIVES: To evaluate the role of stone size on the efficacy and safety of extracorporeal shockwave lithotripsy (ESWL) monotherapy vs ureteroscopy (URS) for managing upper ureteric stones. PATIENTS AND METHODS: The study design was a randomised prospective study of a total cohort of 180 patients with upper ureteric single stones of 0.5-1.5 cm. Half of the patients were managed by ESWL monotherapy, while the other half underwent URS with stone fragmentation using an ultrasound lithotripter (URSL). The success rate, re-treatment rate, auxiliary procedure (AP) rate, efficacy quotient, and complications were compared between the two groups. RESULTS: After single URSL and ESWL procedures 70/90 (77.8%) and 35/90 (38.9%) of the stones were successfully cleared, respectively (P < 0.001). The re-treatment rate after ESWL was significantly higher than in the URSL group (38.9% vs 11.1%, P < 0.001). Requiring an AP was not significantly different following ESWL (22.2%) and URSL (24.4%) treatment. The overall stone-free rate (SFR) at 3 months was significantly superior in the URSL group (88.9% vs 77.8%); however, both procedures had excellent results with no significant difference for stones of <1 cm (95.5% vs 92.9%, P > 0.05), compared to better results following URSL for stones of >1 cm (82.6% vs 64.6%, P < 0.05). CONCLUSION: Our present study supports that ESWL is recommended as a first-line non-invasive monotherapy for upper ureteric opaque stones of <1 cm, while URSL is recommended as a first-line treatment for stones of >1 cm. The results for URSL were superior with lower a re-treatment rate, rapid stone clearance in a very short time, and less radiation exposure. Therefore, stone size is an important factor for the final decision of the initial management of upper ureteric stones because it has a direct relation to the efficacy of ESWL, but it has no effect on the results of URSL.
ABSTRACT
Objective: To evaluate the role of extracorporeal shockwave lithotripsy (ESWL) for the management of 'forgotten' encrusted stents. Patients and Method: This is a retrospective study of 133 patients with forgotten JJ stents, treated between January 2015 and January 2018. Encrustation was mainly found in the renal coil of the stent with distal concomitant encrustation in the vesical and/or ureteric segment. After laboratory and radiological assessment, treatment started with ESWL for the renal encrustation before successful extraction. Auxiliary endourological procedures were used for the encrusted vesical or ureteric segments. Failed cases underwent open surgery. Results: The mean (SD; range) JJ stent indwelling time was 25.84 (10; 14-70) months. In all, 96 (72.2%) patients were seen after treatment for stone disease. In total, 94 patients (70.7%) were managed by ESWL monotherapy, whilst in 36 (27%) additional endourological procedures were required before successful extraction including: cystolithotripsy 19 patients (52.8%), ureteroscopic lithotripsy eight (22.2%), and percutaneous nephrolithotomy nine (25%). Open surgery was required in only three patients (2.3%). A mean of 0.28 procedures per patient was required before smooth stent extraction. The encrusted stents were removed after the first, second, third, and fourth ESWL sessions in 44 patients (33.1%), 43 (32.3%), 26 (19.5%), and 17 (12.8%), respectively. Patients with forgotten indwelling JJ stents for >2 years had significantly larger and harder encrustation at both JJ coils. Conclusion: ESWL proved a feasible first-line treatment for forgotten encrusted JJ stents. The indwelling time of forgotten stents in the urinary tract is associated with greater encrustation burden, density and multiple sites of encrustation. Abbreviations: CLT: cystolithotripsy; ESWL: extracorporeal shockwave lithotripsy; HU: Hounsfield unit; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; PCNL: percutaneous nephrolithotomy; URL: ureteroscopic lithotripsy.
