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Kilinc MF et al, 2015: Ureteroscopy in proximal ureteral stones after shock wave lithotripsy failure: Is it safe and efficient or dangerous?

Kilinc MF, Doluoglu OG, Karakan T, Dalkilic A, Sonmez NC, Aydogmus Y, Resorlu B.
Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey,
Department of Urology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey,
Department of Urology, Etimesgut Military Hospital, Ankara, Turkey,
Department of Urology, 18 Mart University, Canakkale, Turkey.

Abstract

INTRODUCTION: We assessed the effectiveness of ureteroscopy (URS) in proximal ureteral stones performed after shock wave lithotripsy (SWL) failure, and determined outcomes in terms of success rate, complications, and operation time.

METHODS: We analyzed data of patients with previous unsuccessful SWL (Group I) and the ones that did not have SWL or URS before (Group II) for proximal ureteral stones between December 2007 and August 2014. Group I included 346 patients who underwent complementary URS and Group II 209 patients who underwent primary URS. Success rates, operation time and complications were compared between groups.

RESULTS: Success rates of complementary and primary URS were 78.9% and 80.9%, respectively. The difference in success rates was not statistically significant between groups (p = 0.57). The complication rates of complementary URS was 12.1%, and 9.5% in primary URS (p = 0.49). No statistically significant differences were noted in terms of gender, age, stone size and side, or lithotripter type between groups. The mean operation time and need for balloon dilatation were higher in complementary URS group compared to the primary URS group, and the difference was statistically significant (p < 0.05).

CONCLUSIONS: Complementary URS may be used safely after SWL failure in proximal ureteral stones. Its success rate and morbidities are similar to primary URS, except for longer operation time and an increased need for balloon dilatation.

Can Urol Assoc J. 2015 Sep-Oct;9(9-10):E718-22. doi: 10.5489/cuaj.2745. Epub 2015 Oct 13.

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Comments 1

Hans-Göran Tiselius on Wednesday, 17 February 2016 10:01

The authors report their experience with URS after SWL-failure. The comparison was not randomized and primary URS was apparently used for patients with specific stone situations. It is accordingly difficult to know how solid the conclusion is. Unfortunately there is not any information on the total number of patients that was primarily treated with SWL for proximal ureteral stones during the 7-year period. It can be assumed, however, that the success rate with SWL was lower than expected. Why this is so is difficult to know, but the analgesic method might have been a limiting factor.

The conclusion from the study was that complementary URS was not significantly different than primary URS. But it is of note that as many as 6 patients in Group 1 required open surgery! Ureteral avulsion was the reason in two of these cases was!! If the latter complication was a result of the previous SWL or only a consequence of particularly problematic stones is not possible to elucidate.

My personal reflection from this report is that for proximal ureteral stones attempts always should be made to optimize primary SWL by using appropriate analgesics and patient positioning. Also when repeated sessions of SWL are required to disintegrate stones in the ureter, the complication rate is much lower than with URS.

The authors report their experience with URS after SWL-failure. The comparison was not randomized and primary URS was apparently used for patients with specific stone situations. It is accordingly difficult to know how solid the conclusion is. Unfortunately there is not any information on the total number of patients that was primarily treated with SWL for proximal ureteral stones during the 7-year period. It can be assumed, however, that the success rate with SWL was lower than expected. Why this is so is difficult to know, but the analgesic method might have been a limiting factor. The conclusion from the study was that complementary URS was not significantly different than primary URS. But it is of note that as many as 6 patients in Group 1 required open surgery! Ureteral avulsion was the reason in two of these cases was!! If the latter complication was a result of the previous SWL or only a consequence of particularly problematic stones is not possible to elucidate. My personal reflection from this report is that for proximal ureteral stones attempts always should be made to optimize primary SWL by using appropriate analgesics and patient positioning. Also when repeated sessions of SWL are required to disintegrate stones in the ureter, the complication rate is much lower than with URS.
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