Demirelli E. et al., 2022: Complementary Ureterorenoscopy after extracorporeal Shock Wave Lithotripsy in proximal ureteral stones: success and complications.
Demirelli E, Öğreden E, Tok DS, Demiray Ö, Karadayi M, Oğuz U.
Giresun University, Faculty of Medicine, Department of Urology - Giresun, Turkey.
Prof. Dr. A. İlhan Özdemir Training and Research Hospital, Department of Urology - Giresun, Turkey.
Abstract
Objective: The aim of this study was to demonstrate the effect of extracorporeal shock wave lithotripsy application on the success and complications of ureteroscopic lithotripsy in proximal ureter stones.
Methods: The data of 87 patients who did not respond to shock wave lithotripsy and underwent ureteroscopic lithotripsy were retrospectively analyzed and classified as group I, and 99 patients who received ureteroscopic lithotripsy as primary treatment were classified as group II. Demographic features, response to treatment, and preoperative and postoperative complications were compared between the two groups.
Results: There was no difference between the two groups in terms of gender, operation times, stone sizes, and ureteroscope diameters. (p>0.05). Infective complications such as postoperative fever, pyelonephritis, and urosepsis were similar in both groups (p=0.142, p=0.291, and p=0.948). Stone migration was observed in 10 (11.5%) and 6 (6.1%) patients in groups I and II, respectively (p=0.291). Impacted stone was seen in 47 (54%) patients in group I and in 15 (15.2%) patients in group II (p<0.0001). Mucosal laceration occurred in 11 (12.6%) and 3 (3%) patients in groups I and II, respectively (p=0.028). Ureteral perforation was detected in 3 (3.4%) patients in group I and 1 (1%) patient in group II, whereas ureteral avulsion was not observed in either group (p=0.524).
Conclusions: It was concluded that the application of shock wave lithotripsy before ureteroscopic lithotripsy in proximal ureter stones did not affect the success. Although the results are similar in terms of postoperative infection, shock wave lithotripsy application has been found to increase the risk of stone impaction into the mucosa and ureteral laceration.
Rev Assoc Med Bras (1992). 2022 Aug;68(8):1068-1072. doi: 10.1590/1806-9282.20220237. PMID: 36134836. FREE ARTICLE
Comments 1
In this report the authors compared URS carried out as primary treatment and URS as secondary treatment after primary SWL for proximal ureteral stones.
The analysis was retrospective, and it is not shown which criteria that were decisive for choice of the initial treatment modality. It is of note that among 1103 patients treated with URS, 99 had this treatment as primary approach and 138 as secondary procedure after failed SWL. Of note is that as many as 51 patients in the SWL group had missing data!
The bottom-line was that failed SWL did not negatively affect the outcome of secondary URS. Impaction of ureteral stones was significantly more common in the SWL-treated group and the same was found for mucosa laceration. It is not known, however, if the SWL treated stones had been in the ureter for a longer period than those primarily treated with URS. This can be suspected because as many as three sessions of SWL were allowed before the treatment was concluded as failure. One reason for SWL failure might have been explained by difficulties to adequately hit stones close to the SI-joint.
Albeit SWL was carried out with the Dornier HM3-device it was not mentioned whether the lithotripter was modified or what kind of anesthesia that was used.
Hans-Göran Tiselius