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Etafy M et al, 2014: Management of lower ureteric stones: a prospective study.

Etafy M, Morsi GA, Beshir MS, Soliman SS, Galal HA, Ortiz-Vanderdys C
Jackson Health System, Miami, FL, USA.
Faculty of Medicine, Urology Department, Al-Azhar University, Assiut, Egypt.
Universidad Central de Venezuela, Escuela de Medicina Luis Carreño, Caracas, Venezuela.

 

Abstract

OBJECTIVE: To discuss the current concepts in lower ureteric stone management.
MATERIAL AND METHODS: Between October 2008 and November 2010, 190 patients of both sexes and of different age groups with lower ureteric stones, underwent in situ extracorporeal shock wave lithotripsy (ESWL) (48 cases), ureterorenoscopy (URS) (120 cases) and open stone surgery (OSS) (22 cases). The patients' clinical and radiological findings, as well as stone characteristics, were reviewed and correlated with the stone-free status.
RESULTS: In the ESWL group, the operative time was 43.13 +22.5 min; the average number of sessions/patients was 1.5 sessions; the average number of SW/patients was 4500 SW/patients; the average energy was 16.5 kV; the average stone burden was 7.8/mm; the overall stone-free rate was 75% (36/48); and the average radiation exposure time was 3.5 min. In the URS group, the operative time was 49.21 +16.09 min; the average stone burden was 10.81mm; the overall stone-free rate was 97.5% (117/120); the average hospital stay was 3.99 days; and the
average radiation exposure time was 0.75 min. In the OSS group, the operative time was 112.38 +37.1 min; the overall stone-free rate was 100% (22/22); and the average hospital stay was 9.74 days.
CONCLUSION: In the management of patients with lower ureteral stones, URS, SWL and OSS were considered acceptable treatment options. This recommendation was based on the stone-free results, morbidity and retreatment rates for each therapy.

Cent European J Urol. 2014;66(4):456-62. doi: 10.5173/ceju.2013.04.art19. Epub 2014 Jan 27.

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Comments 1

Peter Alken on Tuesday, 26 August 2014 10:31

That is a very unusual publication: it collects data from patients treated in a non-randomized fashion between 2008 and 2010 in three clinics in the US, in Egypt and in Venezuela. The publication may be quoted because it offers data on 22 cases of open surgery in modern times.
But the way the ureter was treated in the surgical cases is difficult to understand: ”In cases where a ureteric stricture was present, a stent was left behind.” But “If no stricture was found then an uretero vesical reimplantation combined with anti–reflux techniques were performed followed by the insertions of an ureteral stent.” Why would they leave a stricture untreated?

That is a very unusual publication: it collects data from patients treated in a non-randomized fashion between 2008 and 2010 in three clinics in the US, in Egypt and in Venezuela. The publication may be quoted because it offers data on 22 cases of open surgery in modern times. But the way the ureter was treated in the surgical cases is difficult to understand: ”In cases where a ureteric stricture was present, a stent was left behind.” But “If no stricture was found then an uretero vesical reimplantation combined with anti–reflux techniques were performed followed by the insertions of an ureteral stent.” Why would they leave a stricture untreated?
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