Pneumatic lithotripsy for large ureteral stones: is it the first line treatment?

To evaluate the effectiveness of pneumatic lithotripsy (PL) with ureteroscopy in the treatment of large ureteral stones. We reviewed, retrospectively, the records of 156 patients (122 male, 34 female) who had ureteral calculi larger than 10 mm that were treated with PL. Of these patients, 41 (26.3%)...

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Bibliographic Details
Published in:International urology and nephrology 2007-09, Vol.39 (3), p.759-764
Main Authors: Tunc, Lutfi, Kupeli, Bora, Senocak, Cagri, Alkibay, Turgut, Sözen, Sinan, Karaoglan, Ustunol, Bozkirli, Ibrahim
Format: Article
Language:English
Subjects:
Adult
Aged
Female
Humans
Length of Stay
Lithotripsy - methods
Male
Middle Aged
Retrospective Studies
Stents
Treatment Outcome
Ureteral Calculi - therapy
Ureteroscopy
Urinary Catheterization
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Summary:To evaluate the effectiveness of pneumatic lithotripsy (PL) with ureteroscopy in the treatment of large ureteral stones. We reviewed, retrospectively, the records of 156 patients (122 male, 34 female) who had ureteral calculi larger than 10 mm that were treated with PL. Of these patients, 41 (26.3%) were treated primarily with PL and 115 (73.7%) were treated secondarily after unsuccessful extracorporeal shock wave lithotripsy (SWL). The mean stone diameter was 12.87 mm (range 10-20.5 mm). Results were evaluated 3 months after treatment by excretory urography and/or ultrasonography. The overall stone-free and fragmentation rates (FRs) were 85.2 and 92.3%, respectively. Corresponding values were 60 and 84% for upper ureteral stones, 79.5 and 89.7% for middle ureter stones and 94.5 and 95.6% for lower ureteral stones, respectively. The main complications were migration of a complete stone or of fragments (7.1%), urosepsis (4.5%) and ureteral perforation (1.3%). Although SWL is generally accepted as the first treatment option for ureteral stones because of its non-invasive nature, PL with ureteroscopy seems to be a good alternative with the advantage of higher success rates and quick stone clearance. Especially when we take the importance of quick stone removal into account for larger ureteral stones, which are more likely to have obstruction, impaction, or infection, we believe that PL may be chosen as the first line treatment rather than SWL for stones larger than 10 mm.
ISSN:0301-1623
1573-2584
DOI:10.1007/s11255-006-9084-7