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