scholarly journals The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

2013 ◽  
Vol 7 (11-12) ◽  
pp. 673 ◽  
Author(s):  
Ufuk Ozturk ◽  
Nevzat Can Şener ◽  
H.N. Goksel Goktug ◽  
Adnan Gucuk ◽  
Ismail Nalbant ◽  
...  
Keyword(s):  
Shock Wave ◽  
Shock Wave Lithotripsy ◽  
Ureteral Stones ◽  
Complication Rates ◽  
Success Rates ◽  
Retrograde Intrarenal Surgery ◽  
Flexible Ureterorenoscopy ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Invasive Method

Introduction: In this study we compare the success rates and complication rates of shock wave lithotripsy (SWL), laparoscopic, and ureteroscopic approaches for large (between 1 and 2 cm) proximal ureteral stones.Methods: In total, 151 patients with ureteral stones between 1 and 2 cm in diameter were randomized into 3 groups (52 SWL, 51 laparoscopy and 48 retrograde intrarenal surgery [RIRS]). The groups were compared for stone size, success rates, and complication rates using the modified Clavien grading system.Results: Stone burden of the groups were similar (p = 0.36). The success rates were 96%, 81% and 79%, respectively in the laparoscopy, SWL, and ureteroscopy groups. The success rate in laparoscopy group was significantly higher (p < 0.05). When these groups were compared for complication rates, RIRS seemed to bethe group with the lowest complication rates (4.11%) (p < 0.05). SWL and laparoscopy seem to have similar rates of complication (7.06% and 7.86%, respectively, p = 0.12).Interpretation: To our knowledge, this is the first study to compare the results of laparoscopy, SWL and RIRS in ureteral stones. Our results showed that in management of patients with upper ureteral stones between 1 and 2 cm, laparoscopy is the most successful method based on its stone-free rates and acceptable complication rates. However, the limitations of our study are lack of hospital stay and cost-effectiveness data. Also, studies conducted on larger populations should support our findings. When a less invasive method is the only choice, SWL and flexible ureterorenoscopy methods have similar success rates. RIRS, however, has a lower complication rate than the other approaches.

scholarly journals Comparison of semirigid ureteroscopy, flexible ureteroscopy, and shock wave lithotripsy for initial treatment of 11-20 mm proximal ureteral stones

2020 ◽  
Vol 92 (1) ◽  
pp. 39-44
Author(s):  
Ibrahim Kartal ◽  
Burhan Baylan ◽  
Mehmet Çağlar Çakıcı ◽  
Sercan Sarı ◽  
Volkan Selmi ◽  
...  
Keyword(s):  
Shock Wave ◽  
Shock Wave Lithotripsy ◽  
The Other ◽  
Flexible Ureteroscopy ◽  
Ureteral Stones ◽  
Complication Rates ◽  
Related Complication ◽  
Lower Complication ◽  
Proximal Ureter ◽  
Stone Characteristics

Objective: We aimed to retrospectively evaluate the effectiveness and safety of flexible ureteroscopy (f-URS), semirigid ureteroscopy (sr-URS), and shock wave lithotripsy (SWL) to treat single 11-20 mm stones in the proximal ureter. Materials and methods: Patients treated at our clinic for 11-20 mm single stones in the proximal ureter who underwent f-URS, sr-URS or SWL as initial lithotripsy methods were compared in terms of their clinical characteristics and treatment outcomes. Results: A comparison among 201 patients who had undergone f-URS, 119 patients who had undergone sr-URS, and 162 patients who had undergone SWL showed no significant baseline differences in patients’ demographic and stone characteristics. Stone-free rates on the 15th day and 3rd month were higher with f-URS (89.6% and 97%, respectively) than with sr-URS (67.2% and 94.1%, respectively) and SWL (41.4% and 79.0%, respectively; all p < 0.001). Retreatment rates were significantly higher with SWL than with the other two modalities (p < 0.001); auxiliary procedure rates were significantly lower with f-URS than with the other two modalities (p < 0.001). Treatment-related complication rate at the end of the 3rd month was lower with f-URS than with SWL (p = 0.022). Furthermore, f-URS was more effective than sr-URS for treating impacted stones. Conclusions: We found that f-URS was highly successful as an initial lithotripsy procedure for medium-sized proximal ureteral stones, and it helped achieve early stone-free outcomes with a lower need for retreatment and auxiliary procedures, lower complication rates, and higher effectiveness on the impacted stones compared with sr-URS and SWL.

scholarly journals Comparison of ureteroscopy (URS) complementary treatment after extracorporeal shock wave lithotripsy failure with primary URS lithotripsy with holmium laser treatment for proximal ureteral stones larger than10mm

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feng Yao ◽  
XiaoLiang Jiang ◽  
Bin Xie ◽  
Ning Liu
Keyword(s):  
Shock Wave ◽  
Logistic Regression ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Ureteral Stones ◽  
Complication Rates ◽  
Complementary Treatment ◽  
Extracorporeal Shock Wave ◽  
Operative Complications ◽  
Group 1

Abstract Background To compare ureteroscopy (URS) complementary treatment following extracorporeal shock wave lithotripsy (SWL) failure with primary URS lithotripsy for proximal ureteral stones > 10 mm, and try to find out acceptable number of SWL sessions followed by safe URS. Methods This was a retrospective study following approval from Medical Ethics Committee of People's Hospital of Chongqing Banan District. Patients (n = 340) who received URS in our hospital for stones > 10 mm from Jan 2015 to June 2020 were divided into two groups according to their previous SWL history. Group 1 consisted of 160 patients that underwent unsuccessful SWL before URS. Group 2 encompassed 180 patients without SWL before URS. Patient’s operative outcomes were compared. A logistic regression and receiver operator characteristics (ROC) were used to identify the acceptable number of SWL sessions prior to URS, regarding the intra-operative complications of URS. Results The group 1 required more surgery time (41.38 ± 11.39 min vs. 36.43 ± 13.36 min, p = 0.01). At the same time, more intra-operative (68.1% VS 22.8%, p < 0.05) and post-operative (35% VS 18.0%, p = 0.001) complications occurred in group 1. Need more hospital stay in group 1 (2.7 ± 1.2 days vs 1.6 ± 1.1 days, p < 0.05). More patients in group 1 need further URS (16.3% VS 8.9%, p = 0.029). After second URS, the SFR of URS in two groups was insignificant differences (82.5% VS 88.9%, p > 0.05). The median (25–75%) of SWL sessions before URS was 2 (1–3) in group 1. According to the results of logistic regression analysis, patients suffered more SWL failure have an increased risk of complications during URS (OR = 1.995, 95% CI: 1.636–2.434). ROC showed that the optimal number of SWL session followed by URS were 0.5, with a sensitivity of 67.7% and specificity of 71.5%. Intra-operative complication rates of URS treatment were higher in patients who suffered > 1 SWL failure (72.6% vs 57.4%, p = 0.047). Conclusion There was no acceptable number of SWL sessions that could be followed by URS with fewer intra-operative complications. Patients who underwent previous SWL were likely to suffer more intra-operative complications, the average operating time, hospitalization time, and needing further treatment, during URS treatment for proximal ureteral stones larger than 10 mm.

scholarly journals Management of upper ureteral stones exceeding 15 mm in diameter: Shock wave lithotripsy versus semirigid ureteroscopy with holmium:yttrium–aluminum–garnet laser lithotripsy

2016 ◽  
Vol 4 ◽  
pp. 205031211668518 ◽  
Author(s):  
Hamdy Aboutaleb ◽  
Mohamed Omar ◽  
Shady Salem ◽  
Mohamed Elshazly
Keyword(s):  
Shock Wave ◽  
Shock Wave Lithotripsy ◽  
Perioperative Complications ◽  
Operation Time ◽  
Laser Lithotripsy ◽  
Ureteral Stones ◽  
Complication Rates ◽  
Stone Free Rate ◽  
Free Rate

Objectives: We conducted a retrospective study to evaluate the efficacy and outcome of shock wave lithotripsy versus semirigid ureteroscopy in the management of the proximal ureteral stones of diameter exceeding 15 mm. Methods: During the 2009−2014 study period, 147 patients presenting with the proximal ureteral stones exceeding 15 mm in diameter were treated. Both shock wave lithotripsy and ureteroscopy with laser lithotripsy were offered for our patients. A 6/8.9 Fr semirigid ureteroscope was used in conjunction with a holmium:yttrium–aluminum–garnet laser. The stone-free rate was assessed at 2 weeks and 3 months post-treatment. All patients were evaluated for stone-free status, operation time, hospital stay, perioperative complications, and auxiliary procedures. Results: Of the 147 patients who took part in this study, 66 (45%) had undergone shock wave lithotripsy and 81 (55%) underwent ureteroscopy. At the 3-month follow-up, the overall stone-free rate in the shock wave lithotripsy group was 39/66 (59%) compared to 70/81 (86.4%) in the ureteroscopic laser lithotripsy group. Ureteroscopic laser lithotripsy achieved a highly significant stone-free rate ( p = 0.0002), and the mean operative time, auxiliary procedures, and postoperative complication rates were comparable between the two groups. Conclusion: In terms of the management of proximal ureteral stones exceeding 15 mm in diameter, ureteroscopy achieved a greater stone-free rate and is considered the first-line of management. Shock wave lithotripsy achieved lower stone-free rate, and it could be used in selected cases.

scholarly journals Comparison of Ureteroscopy (URS) Complementary Treatment after Extracorporeal Shock Wave Lithotripsy Failure with Primary URS Lithotripsy with Holmium Laser Treatment for Proximal Ureteral Stones Larger than 10mm

2021 ◽  
Author(s):  
Feng Yao ◽  
XiaoLiang Jiang ◽  
Bin Xie ◽  
Ning Liu
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Operating Time ◽  
Ureteral Stones ◽  
Complication Rates ◽  
Complementary Treatment ◽  
Extracorporeal Shock Wave ◽  
Operative Complications ◽  
Group 1

Abstract Background: To compare ureteroscopy (URS) complementary treatment following extracorporeal shock wave lithotripsy (SWL) failure with primary URS lithotripsy for proximal ureteral stones ＞ 10 mm, and try to find out optimal SWL session followed by safe URS.Methods: This was a retrospective study following approval from Medical Ethics Committee of People's Hospital of Chongqing Banan District. Patients (n=340) who received URS in our hospital for stones ＞10 mm from Jan 2015 to June 2020 were divided into two groups according to their previous SWL history. Group 1 consisted of 160 patients that underwent unsuccessful SWL before URS. Group 2 encompassed 180 patients without SWL before URS. Patient’s operative outcomes were compared. Receiver operator characteristics were used to identify the optimal SWL session, regarding the intra-operative complications of URS.Results: The group 1 required more surgery time (41.38 ± 11.39 min vs. 36.43 ± 13.36 min, P=0.01). At the same time, more intra-operative (68.1% VS 22.8%, p = 0.000) and post-operative (35% VS 18.0%, p = 0.001) complications occurred in group 1. Need more hospital stay in group 1 (2.7 ± 1.2 days vs 1.6 ± 1.1 days, p < 0.05). More patients in group 1 need further URS (16.3% VS 6.7%, p = 0.004). After second URS, the SFR of URS was insignificant differences (82.5% VS 88.9%, p＞ 0.05). The median (25% - 75%) of SWL sessions before URS was 2(1-3) in group 1. The optimal SWL session followed by URS were 0.5 (Area Under Curve = 0.718, p ＜ 0.001) with a sensitivity of 67.7% and specificity of 71.5%. Intra-operative complication rates of URS treatment were higher in patients who suffered ＞ 1 SWL failure (72.6% vs 57.4%, p = 0.047).Conclusion: There was no optimal SWL session that could be followed by URS with fewer intra-operative complications. Patients who underwent previous SWL were likely to suffer more intra-operative complications, the average operating time, hospitalization time, and needing further treatment, during URS treatment for proximal ureteral stones larger than 10 mm.

scholarly journals Clinical Assessment of Ultrasound-Guided Local Lauromacrogol Injection Combined With Curettage and Hysteroscopy for Cesarean Scar Pregnancy

2020 ◽  
Vol 11 ◽  
Author(s):  
Qing Wu ◽  
Xia Liu ◽  
Lin Zhu ◽  
Yichen Zhu ◽  
Tingting Mei ◽  
...  
Keyword(s):  
Medication Cost ◽  
Complication Rates ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Artery Embolization ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Minimal Invasion

Background: To evaluate the efficacy, safeness and cost of ultrasound-guided local lauromacrogol injection (USG-LLI) combined with curettage and hysteroscopy for cesarean scar pregnancy (CSP).Methods: This was a retrospective study included 151 CSP patients diagnosed with CSP from June 2017 to December 2019, and treated by USG-LLI (n = 86) or uterine artery embolization (UAE) (n = 65) combined with curettage and hysteroscopy. Clinical data and outcome were analyzed.Results: There were no significant differences in basic clinical characteristics in the two groups. Two groups showed the similar success rates. USG-LLI group, compared with UAE group had significantly lower complication rates (9.30 vs. 44.62%), lower total costs (both medical and non-medication cost) (p &lt; 0.05).Conclusions: USG-LLI combined with curettage and hysteroscopy is a feasible method to treat CSP with minimal invasion and high efficacy. Moreover, compared with curettage after UAE, USG-LLI exhibited lower complication rate and required fewer expenses.

Role of computed tomography morphodensitometry in predicting the outcome of shock wave lithotripsy

2018 ◽  
Vol 11 (5) ◽  
pp. 325-330
Author(s):  
Vazir Singh Rathee ◽  
Vivek HC ◽  
Sartaj Wali Khan ◽  
AK Singh ◽  
Pushpendra Kumar Shukla ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Shock Wave ◽  
Treatment Outcome ◽  
Shock Wave Lithotripsy ◽  
Treatment Success ◽  
Treatment Strategies ◽  
Ureteral Stones ◽  
Success Rates ◽  
Level Of Evidence ◽  
Residual Stone

Objectives: The objective of this study was to predict the outcome of shock wave lithotripsy (SWL) on the basis of computed tomography (CT) morphodensitometry for ureteral and renal stones. We also assessed the possibility that Hounsfield unit (HU) values and the location of the stones could be used to predict the outcome of SWL. Material and methods: A prospective study was performed to measure stone size, location, composition, surface area, surface volume, stone burden, the skin-to-stone distance and the HU for solitary renal and ureteral stones by non-contrast CT studies (NCCT) from August 2013 to September 2015. Success of SWL was defined as: (1) being stone-free or (2) residual stone fragments < 4 mm by radiography/NCCT. Results: Of the 100 assessed patients, 68 patients (68%) were stone-free, 12 (12%) had residual stone fragments < 4 mm (clinically insignificant residual fragments) and 20 (20%) had residual stone fragments ≥ 4 mm/ancillary procedures. Multivariate analysis revealed that stone location and mean HU were significant predictors of SWL success. Receiver operating characteristic curves defined cut-off values for predicting treatment outcome. Treatment success rates were significantly higher for stones < 800 HU than with stones > 800 HU ( p = 0.160). Conclusion: Evaluation of stone HU values and stone location prior to SWL can predict treatment outcome and aid in the development of treatment strategies. Level of evidence 2 & 4

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