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Phipps S et al, 2013: Extracorporeal shockwave lithotripsy to distal ureteric stones: the transgluteal approach significantly increases stone-free rates

Phipps S, Stephenson C, Tolley D
Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, UK


Abstract

OBJECTIVE: To compare the outcomes of extracorporeal shockwave lithotripsy (ESWL) for distal ureteric stones treated using the prone and transgluteal (supine) approaches in a tertiary referral stone unit using a fourth generation lithotriptor.

PATIENTS AND METHODS: We selected consecutive patients undergoing ESWL to distal ureteric stones over 1 year, during which we changed our treatment protocol from a prone to transgluteal (supine) approach. Patients were treated using the Sonolith Vision Lithotriptor (Technomed Medical Systems, Vaulx-en-Velin, France). Outcome was assessed using plain abdominal film of kidney, ureter and bladder (KUB) X-ray taken at 2 weeks then monthly as required. Treatment success was defined as complete clearance of stone fragments and treatment failure was defined as persistence of stone fragments beyond 3 months or the need for ureteroscopy.

RESULTS: A total of 38 patients were treated in the prone position and 72 patients using a transgluteal approach. Patient and stone characteristics were identical in bothm groups. The mean (range) stone size was 7.8 (4–16) mm. The proportions of patients who were stone-free after one treatment session within the prone and transgluteal treatment groups were 40 and 78%, respectively (p< 0.001). The overall success rates for treatment within the prone and transgluteal groups were 63 and 92%, respectively (p< 0.001).

CONCLUSIONS: Transgluteal ESWL to stones within the distal ureter leads to significantly higher stone-free rates than treatment using the prone approach. The majority of patients are rendered stone-free after one session of treatment and the overall success rates are similar to those of ureteroscopic management.

BJU Int. 2013 Jan 29. doi: 10.1111/j.1464-410X.2012.11738.x. [Epub ahead of print]
PMID:23360696 [PubMed - as supplied by publisher]

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Comments 1

Peter Alken on Monday, 01 April 2013 07:18

ESWL of distal ureteral stones in a supine position has been described in several modifications with different lithotripters and very good results:

Guntekin E, et al. (1994) Morbidity associated with patient positioning in extracorporeal shock wave lithotripsy of distal ureteral calculi. Int Urol Nephrol 26(l):13–16

Becht E, et al. (1988) Treatment of prevesical ureteral calculi by extracorporeal shock wave lithotripsy. J Urol 139:916–918

Miller K, Hautmann R (1987) Treatment of distal ureteral calculi with SWL: experience with more than 100 consecutive cases. World J Urol 5:259–261

Ackaert KS, et al. (1989) Treatment of distal ureteral stones in the horse riding position. J Urol 142:955–957

Sun X, et al. Greater and lesser ischiadic foramina as path of shock wave lithotripsy for distal ureteral stone in children. J Urol 2010; 184: 665–8

Istanbulluoglu MO, et al. Shock wave lithotripsy for distal ureteric stones: supine or prone. Urol Res 2011; 39: 177–80

Successful application of the technique with individual lithotripters will depend on the positioning facilities, the geometry of the localization system and the shock wave cone.

Peter Alken

ESWL of distal ureteral stones in a supine position has been described in several modifications with different lithotripters and very good results: Guntekin E, et al. (1994) Morbidity associated with patient positioning in extracorporeal shock wave lithotripsy of distal ureteral calculi. Int Urol Nephrol 26(l):13–16 Becht E, et al. (1988) Treatment of prevesical ureteral calculi by extracorporeal shock wave lithotripsy. J Urol 139:916–918 Miller K, Hautmann R (1987) Treatment of distal ureteral calculi with SWL: experience with more than 100 consecutive cases. World J Urol 5:259–261 Ackaert KS, et al. (1989) Treatment of distal ureteral stones in the horse riding position. J Urol 142:955–957 Sun X, et al. Greater and lesser ischiadic foramina as path of shock wave lithotripsy for distal ureteral stone in children. J Urol 2010; 184: 665–8 Istanbulluoglu MO, et al. Shock wave lithotripsy for distal ureteric stones: supine or prone. Urol Res 2011; 39: 177–80 Successful application of the technique with individual lithotripters will depend on the positioning facilities, the geometry of the localization system and the shock wave cone. Peter Alken
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