Demirbas M et al, 2012: Extracorporeal shockwave lithotripsy for ureteral stones: twelve years of experience with 2836 patients at a single center
Demirbas M, Samli M, Karalar M, Kose AC
Private Medicabil Hospital, Bursa, Turkey
PURPOSE: To retrospectively analyze the efficacy of extracorporeal shockwave lithotripsy (SWL) for managing ureteral stones in patients who were treated during a 12-year period at a single center in Turkey.
MATERIALS AND METHODS: The study involved 3300 patients who had single ureteral stone and underwent SWL between January 1999 and March 2011. Medical records from 2836 (85%) patients were available for evaluation. Only patients with radiopaque stones of 5- to 15-mm diameter were included. All procedures were carried out by an experienced urologist (ACK). Patients with proximal ureteral calculi were treated in supine position. Those with mid or distal ureteral stones were treated in modified prone position. Persistence of radiologic image of the stone after three SWL sessions or no spontaneous passage of stone fragments after one month of follow-up was defined as treatment failure. Treatment success was defined as radiologically confirmed fragmentation and spontaneous passage of the stone.
RESULTS: The success rates for the subgroups with stones located in the proximal, mid, and distal ureter were 85.1%, 83.9%, and 88.4%, respectively (P = .257). The success rates for individuals with smaller stones (≤ 10 mm) in the proximal, mid, and distal ureter were 90%, 85.8%, and 90.4%, respectively (P = .07). The corresponding rates for individuals with larger stones (> 10 mm) were 75.3%, 81.3%, and 81.6%, respectively (P = .09).
CONCLUSION: Our retrospective evaluation of this large patient series reveals that SWL is effective for treating stones in the proximal, mid, and distal ureter.
Urol J. 2012 Summer;9(3):557-61
PMID:22903477[PubMed - in process]
In this large (N= 2836 patients) retrospective series of ESWL for ureteral stones, stone free rates in the range 84-88% were obtained. Although the authors generally used supine position for all proximal ureteral stones (down to the iliac crest) it is not mentioned if any problems were encountered with this approach for stones located close to the skeleton. The pre-treatment administration of simethicone might have been of clinical importance, but it is not clearly described how efficient this regimen was to eliminate intestinal gas. Was the absence of intestinal gas an explanation for better outcome for left ureteral stones?
In my own experience the total number of ESWL sessions was relatively high. It is of note that the authors added pethidine in order to get a satisfactory analgesic effect when the patients reported pain, but it is not mentioned how often this analgesic regimen was used in addition to the basic administration of diclofenac. It is, moreover, problematic that as many as 15% of the ESWL treated patients were lost to follow-up.