Advertisement
Poster Session 7: Stone disease| Volume 8, ISSUE 8, P644, September 2009

S111 Management of ureteral calculi: shockwave lithotripsy or ureteroscopy?

      Introduction and Objectives

      To investigate and compare the efficacy and safety of shockwave lithotripsy (SWL) and ureteroscopy (URS) in the treatment of ureteral calculi.

      Material and Methods

      A total of 716 patients with ureteral calculi, who were treated for a period of 18 months (January 2005 – July 2006) were enrolled in this comparative study. The patients were divided in 3 groups: 459 patients (64%) underwent ESWL, 249 (35%) – ureteroscopy and 8 (1%) – open surgical ureterolithotomy. Electromagnetic machine Lithostar Multiline (Siemens, Germany) was used for lithotripsy using power levels from 17 kV to 23 kV. 211 (46%) patients required more than one SWL session. With the patient under spinal or general anesthesia, in the lithotomy position, ureteroscopy was conducted using a semirigid ureteroscope 8.5 Fr (Olympus, Germany). An ultrasound generator LUS-2 (Olympus, Germany) and Holmium YAG laser (VersaPlus, Power Suite) were used for intralumenal lithotripsy. Ureteral stent was inserted only in the presence of indications for stenting. The patients, in whom previous SWL and ureteroscopy were unsuccessful, underwent open surgery. Plain abdominal x-rays and ultrasound scans were obtained 3 months after the procedure.

      Results

      The demographic and clinical characteristics of all patients are statistically similar. At the third month postoperatively, 353 out of 459 (76%) patients in the SWL group, 212 out of 249 (85%) in the ureteroscopy with energetic stone disintegration group and 8 (100%) patients in the open surgery group, were free of residual stone fragments. The success rates depending on stone location in the proximal, mid- and distal ureter, were 80%, 72% and 78% for the SWL group and 74%, 82% and 100% for the URS group, respectively. Patients with unsuccessful URS due to proximal stone migration required insertion of double J stent and subsequent SWL. Patients with unsuccessful SWL, required an attempt of stone reposition and/or insertion of double J stent, and a second session of SWL 7 days after the first procedure. In cases of failure a ureteroscopy was performed. Only in 8 patients with ureteral calculi these 2 treatment methods were unsuccessful and an open surgical ureterolithotomy was performed.

      Conclusions

      Our results show that both URS and SWL as monotherapy or in combination are highly effective treatment methods of ureteral calculi. Open surgical ureterolithotomy is performed in only 1% of patients, in whom these treatment methods or the combination between the two of them were unsuccessful. SWL is safer and minimally invasive method that requires no anesthesia and in most cases no hospitalization of the patient, but on the other hand its success rate is lower and/or requires additional procedures. URS is a more effective method with higher success rate as single procedure and minimal complication rate, but it requires anesthesia and hospitalization of the patient.