Feng C et al, 2013. Ureteroscopic Holmium:YAG laser lithotripsy is effective for ureteral steinstrasse post-SWL
Feng C, Wu Z, Jiang H, Ding Q, Gao P
Department of Urology, Huashan Hospital, Fudan University , Shanghai , China
OBJECTIVE: To evaluate the efficacy of Holmium: YAG laser lithotripsy for ureteral steinstrasse after extracorporeal shock lithotripsy (SWL).
MATERIAL AND METHODS: Holmium: YAG laser lithotripsy was performed on 21 patients who had developed ureteral steinstrasse post-SWL.
RESULTS: Nineteen cases had successful treatment. The ureteral steinstrasse was cleared within one month after the treatment (success rate of 90.48%). Upper ureteral steinstrasse shifted to the renal pelvis was noted in one patient, who underwent a second SWL treatment. Another patient had a severely kinking ureter and underwent open surgery after ureteroscopy failed.
CONCLUSION: Holmium: YAG laser lithotripsy of ureteral steinstrasse post-SWL is an effective clinical modality due to its high success rate, short lithotripsy time, high safety and reliability, and easy feasibility.
Minim Invasive Ther Allied Technol. 2013 Jan 16. [Epub ahead of print]
PMID:23323772 [PubMed - as supplied by publisher]
The authors state "There is currently a dearth of studies reporting the outcomes of endoscopic management of steinstrasse." Rightly so: I remember the many years ago proudly presented slides of a than very well-known British Urologist showing the big kidney stone before and the ureter filled with bricks after ESWL. With proper patient selection Steinstrassse has become a rare event and we are no longer proud of or busy with it.
The manuscript mainly deals with the Ureteroscopy and the authors give no clues why steintrasse formed despite the small stone size. One figure shows rather radiopaque fragments typical for brushite which tends to break up in larger pieces.