[Influence of lithotripsy modalities on complication rate].

INTRODUCTION: Localization of ureteric stones and difference in disintegration success are the most important factors in determining the first treatment approach for ureteric stones. OBJECTIVE: The aim of our study was to evaluate the difference in complication rate between different ureteric stone litho-tripsy modalities. METHODS: Two hundred sixty patients with ureteric stones were analyzed in a prospective bicentric study that lasted 1 year.The patients were divided into two groups: 1-120 patients who underwent ESWL (extracorporeal shockwave lithotripsy) treatment and II-140 patients who were treated endoscopically with ballistic lithotripsy. RESULTS Ureteroscopic lithotripsy of all pelvic and iliac stones was significantly more successful comparing to ESWL, while lumbar ureteric stone treatment with ureteroscopic lithotripsy was not significantly more successful than ESWL, except for lumbar stones larger than 100mm2 that were significantly better treated endoscopically. In the I group complications after lithotripsy were recorded in 64 (59.3%) and in the II group in 58 (42.0%) patients, meaning that complications were statistically significantly more frequent in the I than in the II group. In the II group complications were significantly more often recorded after treatment of proximal comparing to ureteric stones of other localizations, while in the I group complica-tions were significantly more often detected after treatment of impacted stones than in the II group. CONCLUSION: Being significantly successful comparing to ESWL, ureteric stone treatment with ureteroscopic lithotripsy should be considered as the first therapeutic option for all, especially impacted stones located in the iliac and pelvic ureteric portion. In spite of absent statistical difference in the success rate, ESWL should be chosen as the first treatment option in all cases of lumbar ureteric stones due to lower complication rate except for stones larger than 100mm2that should be primarily treated endoscopically.

Do stone size and impaction influence therapeutic approach to proximal ureteral stones?

BACKGROUND/AIM: Primary therapeutic approach to lumbar ureteral stones is still contraversial. The aim of the study was to investigate the influence of stone impaction and size on the effectiveness of proximal ureteral stone lithotripsy. METHODS: A total of 123 patients with proximal ureteral stones were investigated in this prospective study performed in a 10-month period. The patients were divided into the group I--86 patients treated with extracorporeal shock wave lithotripsy (ESWL) and the group II--37 patients treated with "Swiss" Lithoclast. In the group I, 49 stones (57%) were classified as impacted, while 20 stones (23.3%) were larger than 100 mm2. In the group II, 26 stones (70.3%) were impacted, and 11 stones (29.7%) were larger than 100 mm2. Stones were defined as impacted by the radiographic, echosonographic as well as endoscopic findings in the group II of patients. Stone size was presented in mm2. Chemical composition of stones were almost the same in both groups of the patients. RESULTS: Generally, there was no statistically significant difference in the treatment success between the groups. However, stones larger than 100 mm2 were statistically more successfully treated endoscopically, while there was no statistical difference in the treatment success of impacted stones between these two groups. CONCLUSION: ESWL can by considered as primary first therapeutic approach in treatment of all proximal ureteral stones except for stones larger than 100 mm2 that should primarily be treated endoscopically.

[The influence of lithotripsy methods on the incidence of auxilary procedures after ureteric stone desintegration].

INTRODUCTION/AIM: Localization of ureteric stones and the difference in disintegration success are the most important but not the only factors in choosing the first treatment approach to ureteric stones. The aim of the study was to investigate the incidence of auxiliary procedures after different ureteric stones lithotripsy modalities. METHODS: In a prospective bicentric study 260 patients with ureteric stones were analyzed. The patients weve divided into two groups: group I--120 patients subjected to extracorporeal shock ware lithotripsy (ESWL) treatment and group II--140 patients treated endoscopicly with ballistic lithotripsy using "Swiss" Lithoclast. RESULTS: Endoscopic treatment of all distal ureteric stones was significantly more successful than ESWL, but not significantly more successful than ESWL regarding proximal ureteric stones except for stones larger than 100 mm2 that were significantly better treated with endoscopic method. There was no general significant difference in auxiliary procedures rate after lithotripsy between the two groups. In the group I auxiliary procedures were significantly more performed than in the group II after the lithotripsy of stones larger than 100 mm2, calcium-oxalat-monohydrate stones and highly significantly more performed after the treatment of stones located in the iliac ureteric portion and impacted stones. After the lithotripsy of lumbar ureteric stones and multiple stones situated in different ureteric portions additional procedures were highly significantly more necessary in the goup II than in the group I. CONCLUSION: Being significantly more successful comparing to ESWL, ureteric stone treatment with "Swiss" Lithoclast should be considered the first therapeutic option for all, especially impacted stones located in iliac and pelvic ureter. In spite of a statistically significant difference in success rate, ESWL should be performed as the first treatment option in all cases of lumbar stones as well as multiple stones located in different ureteric portion because of lower auxiliary procedures rate except for stones larger than 100 mm2 that should be primarily treated endoscopicly.