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Fragmentation without extraction in ureteral stones: outcomes of 238 cases

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Abstract

We aimed to evaluate the success rates, auxiliary procedures and complications after ureteroscopic lithotripsy (URS) during which the fragments left in situ for spontaneous passage after complete disintegration into a acceptable (<4 mm) size. 238 patients with ureteral stones were treated with URS between 2005 and 2011, and disintegrated fragments (<4 mm) were left in situ for spontaneous passage. Patients were followed with radiography for 3 months and evaluated with respect to the success rates (stone-free), auxiliary procedures, complication rates and additional analgesic requirement. The median age was 42.2 ± 13.7 years, and overall stone size was 8.79 ± 2.94 mm. Significantly lower rate of stone-free status was achieved in proximal stones (p < 0.05). A second URS was necessary in 5% (n = 12) of the patients. Double-J catheter placement during initial URS did not cause any change in the rate of secondary URS (p = 0.620). Additional oral or intramuscular analgesia was required in 41% (n = 97) and 25% (n = 59) of the patients, respectively, after discharge. The overall stone-free rate was 95% and mean time to complete clearance was 5 days. Severe colic pain within 24 h was noted in 21 (9%), and transient hydro-ureteronephrosis in 31 (13%) patients, as minor complications. Leaving the fragments (<4 mm) in place for spontaneous passage following a successful disintegration in URS could be a reasonable approach with acceptable and comparable stone-free rates, and this approach appears to give chance of shortening the duration of operation and also avoiding from the potential morbidity of repeated manipulations during the both further disintegration and extraction.

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References

  1. Stoller ML, Bolton DM (2000) Urinary stone disease. In: Tanagho EA, McAninch JW (eds) Smith’s General Urology. McGraw Hill, New York, pp 291–320

    Google Scholar 

  2. Bierkens AF, Hendrikx AJM, De La Rosette JJMCH et al (1998) Treatment of mid-and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness. Br J Urol 81:31–35

    Article  PubMed  CAS  Google Scholar 

  3. Segura JW, Preminger GM, Assimos DG et al (1997) Ureteral stones clinical guidelines panel summary report on the management of ureteral calculi. J Urol 158:1915–1921

    Article  PubMed  CAS  Google Scholar 

  4. Elsobky E, Sheir KZ, Madbouly K et al (2000) Extracorporeal shock wave lithotripsy in children: experience using two second-generation lithotripters. Br J Urol 86:851–856

    CAS  Google Scholar 

  5. Ghobish A (1998) In situ extracorporeal shockwave lithotripsy of middle and lower ureteral stones: a boosted, stentless, ventral technique. Eur Urol 34:93–98

    Article  PubMed  CAS  Google Scholar 

  6. Shiroyanagi Y, Yagisawa T, Nanri M et al (2002) Factors associated with failure of ESWL for ureteral stones using Dornier lithotriptor U/50. Int J Urol 9:304–307

    Article  PubMed  Google Scholar 

  7. Sayed MAB, Taher AM, Aboul-Ella HA et al (2001) Steinstrasse after extracorporeal shockwave lithotripsy: aetiology, prevention and management. BJU Int 88:675–678

    Article  PubMed  CAS  Google Scholar 

  8. Willis LR, Evan AP, Connors BA et al (1999) Relationship between kidney size, renal injury and renal impairment induced by shock wave lithotripsy. J Am Soc Nephrol 10:1753–1762

    PubMed  CAS  Google Scholar 

  9. Choong S, Whitfield H, Duffy P et al (2000) The management of paediatric urolithiasis. Br J Urol 86:857–860

    CAS  Google Scholar 

  10. Deliveliotis C, Stavropoulos NI, Koutsokalis A et al (1996) Distal ureteral calculi: ureteroscopy versus ESWL. A prospective analysis. Int Urol Nephrol 28:627–631

    Article  PubMed  CAS  Google Scholar 

  11. Küpeli B, Alkibay T, Sınık Z et al (2000) What is the optimal treatment for lower ureteral stones larger than 1 cm? Int J Urol 7:167–171

    Article  PubMed  Google Scholar 

  12. Strohmaier WL, Schubert G, Rosenkranz T et al (1999) Comparison of ESWL and ureteroscopy in the treatment of ureteral calculi: a prospective study. Eur Urol 36:376–379

    Article  PubMed  CAS  Google Scholar 

  13. Bagley DH (1988) Indications for ureteropyeloscopy. In:Huffman JL, Bagley DH, Lyon ES (ed) Ureteroscopy, Philadelphia, pp 17–30

  14. Stoller ML, Wolf JS Jr, Hofmann R et al (1999) Ureteroscopy without routine balloon dilatation: an outcome assessment. J.Urol 147:1238–1241

    Google Scholar 

  15. Daniels GF Jr, Garnett JE, Carter MF (1988) Ureteroscopic results and complications experience with 130 cases. J Urol 139:710–712

    PubMed  Google Scholar 

  16. Netto NR, Claro JA, Esreves SC et al (1997) Ureteroscopic stone removal in the distal ureter. Why change? J Urol 157:2081–2083

    Article  Google Scholar 

  17. Fraser M, Joyce AD, Thomas DFM et al (1999) Minimally invasive treatment of urinary tract calculi in children. Br J Urol 84:339–342

    CAS  Google Scholar 

  18. Tawfiek E, Bagley HD (1999) Management of upper urinary tract calculi with ureteroscopic techniques. Urology 53(1):25–31

    Article  PubMed  CAS  Google Scholar 

  19. Costello AJ, Westcott MJ, Peters JS (2000) Experience with the holmium laser as an endoscopic lithotrite. Aust NZJ Surg 70:348–350

    Article  CAS  Google Scholar 

  20. Yamaguchi K, Minei S, Yamazaki T et al (1999) Characterization of ureteral lesions associated with impacted stones. Int J Urol 6:281–285

    Article  PubMed  CAS  Google Scholar 

  21. Harmon WJ, Sershon PD, Blute ML et al (1997) Ureteroscopy: current practice and long term complications. J Urol 157:28–32

    Article  PubMed  CAS  Google Scholar 

  22. Seitz C, Tanovic E, Kikic Z et al (2007) Impact of stone size, location, composition, impaction, and hydronephrosis on the efficacy of holmium:YAG-laser ureterolithotripsy. Eur Urol 52:1751–1757

    Article  PubMed  Google Scholar 

  23. Brito AH, Mitre AI, Srougi M (2006) Ureteroscopic pneumatic lithotripsy of impacted ureteral calculi. Int Braz J Urol 32(3):295–299

    Article  PubMed  Google Scholar 

  24. Schuster TG, Hollenbeck BK, Faerber GJ et al (2001) Complications of ureteroscopy: analysis of predictive factors. J Urol 166(2):538–540

    Article  PubMed  CAS  Google Scholar 

  25. Preminger GM, Tiselius HG, Assimos DG et al (2007) EAU/AUA: nephrolithiasis guideline panel. Guideline for the management of ureteral calculi. J Urol 178:2418–2434

    Article  PubMed  Google Scholar 

  26. Anagnostou T, Tolley D (2004) Management of ureteric stones. Eur Urol 45:714–721

    Article  PubMed  Google Scholar 

  27. Gettman MT, Segura JW (2005) Management of ureteric stones: issues and controversies. BJU Int 95(suppl 2):85–93

    Article  PubMed  Google Scholar 

  28. Wolf JS Jr (2007) Treatment selection and outcomes: ureteral calculi. Urol Clin North Am 34(3):421–430

    Article  PubMed  Google Scholar 

  29. Ciftci H, Savas M, Altunkol A et al (2010) Influence of stone size, location and impaction on the success of ureteroscopic pneumolithotripsy. Georgian Med News 183:7–12

    PubMed  Google Scholar 

  30. Fuganti PE, Pires S, Branco R et al (2008) Predictive factors for intraoperative complications in semirigid ureteroscopy: analysis of 1235 ballistic ureterolithotripsies. Urology 72((4):770–774 (Epub 2008 Jul 16)

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Urology Clinic, Kartal Training Hospital, Istanbul, Turkey

    Cemal Göktaş, Rahim Horuz, Oktay Akça, Ali Cihangir Çetinel & Selami Albayrak

  2. Department of Urology, Yeditepe University, Istanbul, Turkey

    Kemal Sarıca

Authors
  1. Cemal Göktaş
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  2. Rahim Horuz
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  3. Oktay Akça
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  4. Ali Cihangir Çetinel
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  5. Selami Albayrak
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  6. Kemal Sarıca
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Correspondence to Rahim Horuz.

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Göktaş, C., Horuz, R., Akça, O. et al. Fragmentation without extraction in ureteral stones: outcomes of 238 cases. Urol Res 40, 383–387 (2012). https://doi.org/10.1007/s00240-011-0431-5

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  • DOI: https://doi.org/10.1007/s00240-011-0431-5

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